Provider Demographics
NPI:1174534556
Name:DOAK, SUSAN M (LPC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:DOAK
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 1:901 N BRUTSCHER ST.
Mailing Address - Street 2:STE 204
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-6096
Mailing Address - Country:US
Mailing Address - Phone:503-994-8424
Mailing Address - Fax:503-554-9967
Practice Address - Street 1:901 N BRUTSCHER ST.
Practice Address - Street 2:STE 204
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-6096
Practice Address - Country:US
Practice Address - Phone:503-994-8424
Practice Address - Fax:503-554-9967
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2835101Y00000X
ORLPC2835101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC2835OtherSTATE OF OREGON BOARD OF LICENSED PROFESSIONAL COUNSELORS AND THERAPISTS