Provider Demographics
NPI:1306495833
Name:HIMES, ELISE MADLINE
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:MADLINE
Last Name:HIMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 SE EDGEWAY DR # C134
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3793
Mailing Address - Country:US
Mailing Address - Phone:503-473-3909
Mailing Address - Fax:
Practice Address - Street 1:2926 NE FLANDERS ST STE 3C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3259
Practice Address - Country:US
Practice Address - Phone:971-270-0167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-07
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health