Provider Demographics
NPI:1730830324
Name:AVERY, ANNA KATHERINE (LMFT)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:KATHERINE
Last Name:AVERY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 NW BETHANY BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5208
Mailing Address - Country:US
Mailing Address - Phone:503-567-3260
Mailing Address - Fax:503-567-3264
Practice Address - Street 1:1500 NW BETHANY BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5208
Practice Address - Country:US
Practice Address - Phone:503-567-3260
Practice Address - Fax:503-567-3264
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT2751106H00000X
ORR7493101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist