Provider Demographics
NPI:1114656675
Name:UTRECHT, LES (LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:LES
Middle Name:
Last Name:UTRECHT
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6635 N BALTIMORE AVE STE 275
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-5458
Mailing Address - Country:US
Mailing Address - Phone:312-468-7345
Mailing Address - Fax:
Practice Address - Street 1:6635 N BALTIMORE AVE STE 275
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-5458
Practice Address - Country:US
Practice Address - Phone:312-468-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor