Provider Demographics
NPI:1447655105
Name:NILSEN, XYLEM (LCSW, QMHP)
Entity type:Individual
Prefix:
First Name:XYLEM
Middle Name:
Last Name:NILSEN
Suffix:
Gender:M
Credentials:LCSW, QMHP
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:ANNE
Other - Last Name:NILSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1336 NW FLANDERS ST
Mailing Address - Street 2:PMB 215
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209
Mailing Address - Country:US
Mailing Address - Phone:971-431-8968
Mailing Address - Fax:971-351-6979
Practice Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY STE 560
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4791
Practice Address - Country:US
Practice Address - Phone:971-431-8968
Practice Address - Fax:971-351-6979
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL11474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health