Provider Demographics
NPI:1538362736
Name:CACKOWSKI, LOUISE J (LPC)
Entity type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:J
Last Name:CACKOWSKI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:LOUISE
Other - Middle Name:J
Other - Last Name:CACKOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1890 WAITE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-1229
Mailing Address - Country:US
Mailing Address - Phone:541-756-6232
Mailing Address - Fax:541-756-6234
Practice Address - Street 1:1620 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2150
Practice Address - Country:US
Practice Address - Phone:541-269-2986
Practice Address - Fax:541-266-8640
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC2686101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health