Provider Demographics
NPI:1578384517
Name:LIMINALITY COUNSELING, LLC
Entity type:Organization
Organization Name:LIMINALITY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:SHREVE
Authorized Official - Suffix:
Authorized Official - Credentials:NCC
Authorized Official - Phone:646-496-2344
Mailing Address - Street 1:7500 SW 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6518
Mailing Address - Country:US
Mailing Address - Phone:646-496-2344
Mailing Address - Fax:
Practice Address - Street 1:5319 SW WESTGATE DR STE 113
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2432
Practice Address - Country:US
Practice Address - Phone:646-496-2344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty