Provider Demographics
NPI:1578376349
Name:OPBROEK, MEGHAN LEA (LPC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LEA
Last Name:OPBROEK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 NE JESSUP ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3742
Mailing Address - Country:US
Mailing Address - Phone:503-505-8464
Mailing Address - Fax:
Practice Address - Street 1:817 NE JESSUP ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3742
Practice Address - Country:US
Practice Address - Phone:503-505-8464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC8605101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health