Individual
KELLY GROVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
9755 SW BARNES RD, PORTLAND, OR 97225-6651
(503) 444-4862
Mailing address
3425 N MICHIGAN AVE, PORTLAND, OR 97227-1509
(847) 714-4766
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C7297
OR
101YM0800X
Mental Health Counselor
R6695
OR
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
C7297
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528656493
—
OR
Enumeration date
01/06/2021
Last updated
11/07/2024
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