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:971-319-4106
Mailing Address - Fax:
Practice Address - Street 1:1825 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2844
Practice Address - Country:US
Practice Address - Phone:503-963-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL11474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health