Provider Demographics
NPI:1902442643
Name:WORLEY, GINA MICHELLE (LMFT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MICHELLE
Last Name:WORLEY
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 1:1300 JOHN ADAMS ST STE 109
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1695
Mailing Address - Country:US
Mailing Address - Phone:503-567-6557
Mailing Address - Fax:971-925-4847
Practice Address - Street 1:1300 JOHN ADAMS ST STE 109
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1695
Practice Address - Country:US
Practice Address - Phone:503-567-6557
Practice Address - Fax:971-925-4847
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR4763101YM0800X
ORT2030106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health