Provider Demographics
NPI:1396163556
Name:PRELOG, ESTHER JUNE (LPC)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:JUNE
Last Name:PRELOG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 SW WESTGATE DR STE 108
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2424
Mailing Address - Country:US
Mailing Address - Phone:503-267-3206
Mailing Address - Fax:
Practice Address - Street 1:3731 SE 164TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-1709
Practice Address - Country:US
Practice Address - Phone:503-251-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC3395OtherOREGON BOARD OF LICENSED PROFESSIONAL COUNSELORS AND THERAPISTS