Individual
NICOLE PROPHET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
7227 SE THORBURN ST, PORTLAND, OR 97215-1434
(971) 865-3573
(971) 999-0908
Mailing address
7901 SE POWELL BLVD, STE B, #111, PORTLAND, OR 97206-2331
(971) 865-3573
(971) 999-0908
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C6307
OR
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
08/08/2016
Last updated
11/02/2023
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