Provider Demographics
NPI:1134267875
Name:BENTLEY, KATHERINE ELOUISE (MSW, LCSW, CADC I)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ELOUISE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:MSW, LCSW, CADC I
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:BENTLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4207 SE WOODSTOCK BLVD # 164
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6267
Mailing Address - Country:US
Mailing Address - Phone:503-758-3750
Mailing Address - Fax:
Practice Address - Street 1:3550 N INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1196
Practice Address - Country:US
Practice Address - Phone:503-249-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR04-07-01101YA0400X
ORL4693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)