Organization
IMAGINE LIFE COUNSELING AND CONSULTATION, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEAH RENEE PARTAK LCSW, CADCII, ACS (OWNER / THERAPIST)
(503) 701-2294
Entity
Organization
Contact information
Practice address
2325 E BURNSIDE ST, SUITE 202, PORTLAND, OR 97214-1655
(503) 701-2294
Mailing address
2325 E BURNSIDE ST, SUITE 202, PORTLAND, OR 97214-1655
(503) 701-2294
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11-06-94
OR
1041C0700X
Clinical Social Worker
Primary
L4576
OR
Other
Enumeration date
10/07/2016
Last updated
10/07/2016
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