Provider Demographics
NPI:1427780212
Name:QUEER EXPRESSIONS MENTAL HEALTH COLLECTIVE: INDIVIDUAL & FAMILY COUNSE
Entity type:Organization
Organization Name:QUEER EXPRESSIONS MENTAL HEALTH COLLECTIVE: INDIVIDUAL & FAMILY COUNSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:510-680-3545
Mailing Address - Street 1:1923 NE BROADWAY ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1501
Mailing Address - Country:US
Mailing Address - Phone:503-908-9435
Mailing Address - Fax:
Practice Address - Street 1:1923 NE BROADWAY ST UNIT 5
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1501
Practice Address - Country:US
Practice Address - Phone:503-908-9435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245590884OtherINDIVIDUAL
CA1376956086OtherINDIVIDUAL