Provider Demographics
NPI:1487108460
Name:PROPHET, NICOLE (MS, LPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:PROPHET
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:COLE
Other - Middle Name:
Other - Last Name:PROPHET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:7901 SE POWELL BLVD, STE B
Mailing Address - Street 2:#111
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2331
Mailing Address - Country:US
Mailing Address - Phone:971-865-3573
Mailing Address - Fax:971-999-0908
Practice Address - Street 1:7227 SE THORBURN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1434
Practice Address - Country:US
Practice Address - Phone:971-865-3573
Practice Address - Fax:971-999-0908
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC6307101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health