Provider Demographics
NPI:1427301217
Name:MARCHANT, NICOLE HAXBY (LPC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:HAXBY
Last Name:MARCHANT
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 1:7445 SW ASHDALE CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9323
Mailing Address - Country:US
Mailing Address - Phone:971-322-5164
Mailing Address - Fax:
Practice Address - Street 1:7445 SW ASHDALE CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-9323
Practice Address - Country:US
Practice Address - Phone:971-322-5164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2965101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional