Provider Demographics
NPI:1447543418
Name:COLLIER, ANNA NICHOLE (MA, LPC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:NICHOLE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:A. NICHOLE
Other - Middle Name:
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:10313 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9103
Mailing Address - Country:US
Mailing Address - Phone:503-597-3896
Mailing Address - Fax:503-597-3897
Practice Address - Street 1:527 SE MORRISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214
Practice Address - Country:US
Practice Address - Phone:503-597-3896
Practice Address - Fax:503-597-3897
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2018-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC3000OtherOREGON BOARD OF PROFESSIONAL COUNSELORS & THERAPISTS (OBLPCT)