Provider Demographics
NPI:1750942488
Name:SARGENTI, MICHELLE C (LPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:SARGENTI
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 1:3439 SE HAWTHORNE BLVD # 630
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5048
Mailing Address - Country:US
Mailing Address - Phone:503-905-6501
Mailing Address - Fax:
Practice Address - Street 1:3439 SE HAWTHORNE BLVD # 630
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5048
Practice Address - Country:US
Practice Address - Phone:503-905-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ORC6509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator