Provider Demographics
NPI:1851134720
Name:CEZANNE, CHAR RAE (MA CANDIDATE)
Entity type:Individual
Prefix:
First Name:CHAR
Middle Name:RAE
Last Name:CEZANNE
Suffix:
Gender:F
Credentials:MA CANDIDATE
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:RAE
Other - Last Name:VAN HOOZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 SE 11TH AVE UNIT NX410
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1360
Mailing Address - Country:US
Mailing Address - Phone:805-540-8184
Mailing Address - Fax:
Practice Address - Street 1:1215 SW 18TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1711
Practice Address - Country:US
Practice Address - Phone:503-893-9532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health