Provider Demographics
NPI:1902324122
Name:SENUA COUNSELING CLINIC, LLC
Entity Type:Organization
Organization Name:SENUA COUNSELING CLINIC, LLC
Other - Org Name:SENUA COUNSELING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-705-3009
Mailing Address - Street 1:5300 PARKVIEW DR APT 1017
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8723
Mailing Address - Country:US
Mailing Address - Phone:503-705-3009
Mailing Address - Fax:
Practice Address - Street 1:4800 MEADOWS RD STE 300
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5277
Practice Address - Country:US
Practice Address - Phone:503-705-3009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty