Individual
REBECCA AMETHYST KINMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2404 SE 113TH AVE, PORTLAND, OR 97216-4042
(971) 258-0220
(971) 484-4002
Mailing address
2404 SE 113TH AVE APT A, PORTLAND, OR 97216-4042
(971) 258-0220
(971) 484-4002
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
A13481
OR
1041C0700X
Clinical Social Worker
Primary
L16209
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500809034
—
OR
Enumeration date
07/15/2022
Last updated
03/16/2026
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