Provider Demographics
NPI:1417486671
Name:CENTERED GROWTH COUNSELING, PLLC
Entity type:Organization
Organization Name:CENTERED GROWTH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LMHC, CADC
Authorized Official - Phone:503-765-6209
Mailing Address - Street 1:14511 WESTLAKE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7773
Mailing Address - Country:US
Mailing Address - Phone:503-765-6209
Mailing Address - Fax:
Practice Address - Street 1:7345 164TH AVE NE STE I145
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7848
Practice Address - Country:US
Practice Address - Phone:503-765-6209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-09
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)