Individual
STEPHANIE MARIA CANALES BASURTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12636 SE STARK ST STE 125, PORTLAND, OR 97233-1058
(503) 253-4600
(503) 253-4609
Mailing address
12636 SE STARK ST STE 125, PORTLAND, OR 97233-1058
(503) 253-4600
(503) 253-4609
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
22-12-10524
OR
106H00000X
Marriage & Family Therapist
Primary
T2451
OR
Other
Enumeration date
01/30/2017
Last updated
01/24/2024
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