Provider Demographics
NPI:1871725267
Name:HARRIS IMBS, KAITY MICHELLE (LPC)
Entity type:Individual
Prefix:
First Name:KAITY
Middle Name:MICHELLE
Last Name:HARRIS IMBS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KAITY
Other - Middle Name:MICHELLE
Other - Last Name:HARRIS IMBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:247 COMMERCIAL ST NE STE 204
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3435
Mailing Address - Country:US
Mailing Address - Phone:971-304-5285
Mailing Address - Fax:
Practice Address - Street 1:247 COMMERCIAL ST NE STE 204
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3435
Practice Address - Country:US
Practice Address - Phone:971-304-5285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC3374101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health