Provider Demographics
NPI:1639579154
Name:WIRTZ-WOLD, MOLZ (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:MOLZ
Middle Name:
Last Name:WIRTZ-WOLD
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 N BOWDOIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4101
Mailing Address - Country:US
Mailing Address - Phone:206-200-3241
Mailing Address - Fax:
Practice Address - Street 1:5651 N LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4268
Practice Address - Country:US
Practice Address - Phone:208-907-1625
Practice Address - Fax:206-267-0283
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6618101YM0800X
WALH60344737101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health