Individual
CALLIE HOLGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12636 SE STARK ST BLDG J, PORTLAND, OR 97233-1058
(503) 253-4600
Mailing address
12636 SE STARK ST BLDG J, PORTLAND, OR 97233-1058
(503) 253-4600
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
25-QMHP-R-3348
OR
106H00000X
Marriage & Family Therapist
Primary
R10618
OR
Other
Enumeration date
04/28/2022
Last updated
01/29/2025
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