Provider Demographics
NPI:1770022329
Name:PIKE, DUDLEY (LPC)
Entity type:Individual
Prefix:
First Name:DUDLEY
Middle Name:
Last Name:PIKE
Suffix:
Gender:X
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11635 NE PRESCOTT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-1434
Mailing Address - Country:US
Mailing Address - Phone:815-326-2195
Mailing Address - Fax:
Practice Address - Street 1:333 S FLOWER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3797
Practice Address - Country:US
Practice Address - Phone:815-326-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009745101YP2500X
C4494101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional