Individual
KIMBERLY WIRTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
9135 SW BARNES RD STE 987, PORTLAND, OR 97225-6646
(503) 216-2811
Mailing address
1215 SE CORA ST, PORTLAND, OR 97202-5024
(951) 312-9373
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C7824
OR
101YP2500X
Professional Counselor
Primary
C7824
OR
Other
Enumeration date
01/26/2022
Last updated
01/03/2024
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