Provider Demographics
NPI:1922245513
Name:FARRELL, CARRIE (LPC, LMT)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LPC, LMT
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:KOESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4531 NE 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-3817
Mailing Address - Country:US
Mailing Address - Phone:971-219-0404
Mailing Address - Fax:
Practice Address - Street 1:801 NE ALBERTA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-4529
Practice Address - Country:US
Practice Address - Phone:971-219-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15009172M00000X
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172M00000XOther Service ProvidersMechanotherapist