Organization
INNER COURAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL MAKER LCSW (MEMBER)
(503) 341-4325
Entity
Organization
Contact information
Practice address
21 NE ALBERTA ST, PORTLAND, OR 97211-2601
(503) 341-4325
Mailing address
21 NE ALBERTA ST, PORTLAND, OR 97211-2601
(503) 341-4325
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
2953
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
2953
OR
101YM0800X
Mental Health Counselor
2953
OR
104100000X
Social Worker
2953
OR
1041C0700X
Clinical Social Worker
Primary
2953
OR
106H00000X
Marriage & Family Therapist
2953
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
808138000
REGENCE BCBS OF OREGON
OR
Enumeration date
03/30/2007
Last updated
03/28/2014
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