Provider Demographics
NPI:1912123191
Name:O'DONNELL, ANNE M (MS, LPC, CADC III)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:MS, LPC, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 SW BERTHA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-1101
Mailing Address - Country:US
Mailing Address - Phone:503-460-7013
Mailing Address - Fax:
Practice Address - Street 1:5 CENTERPOINTE DR STE 320
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8696
Practice Address - Country:US
Practice Address - Phone:971-213-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
ORC6186101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health