Provider Demographics
NPI:1366909061
Name:DIRKSE COUNSELING AND CONSULTING, INC.
Entity type:Organization
Organization Name:DIRKSE COUNSELING AND CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-430-5762
Mailing Address - Street 1:9725 SW BEAVERTON HILLSDALE HWY STE 230
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4755
Mailing Address - Country:US
Mailing Address - Phone:503-430-5762
Mailing Address - Fax:503-672-7668
Practice Address - Street 1:9725 SW BEAVERTON HILLSDALE HWY STE 230
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4755
Practice Address - Country:US
Practice Address - Phone:503-430-5762
Practice Address - Fax:503-672-7668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500769429Medicaid