Provider Demographics
NPI:1366946451
Name:MAKOWICHUK, KRISTY CAR (LPC, LMHC)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:CAR
Last Name:MAKOWICHUK
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:CAR
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 B AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2958
Mailing Address - Country:US
Mailing Address - Phone:503-607-7236
Mailing Address - Fax:
Practice Address - Street 1:630 B AVENUE
Practice Address - Street 2:SUITE 9
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034
Practice Address - Country:US
Practice Address - Phone:503-607-7236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4797101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health