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Individual

MRS. JUSTINE CHASE TAYLOR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
5228 NE HOYT ST BLDG B2ND, PORTLAND, OR 97213-3055
(503) 215-6474
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CG60134923
WA
104100000X
Social Worker
L5361
OR
1041C0700X
Clinical Social Worker
Primary
L5361
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500698051
OR
Enumeration date
09/12/2011
Last updated
12/09/2019
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