Basic Information
| Provider Information | |||||||||
| NPI: | 1275258915 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAMINE | ||||||||
| FirstName: | IRINA | ||||||||
| MiddleName: | G | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 SW 5TH AVE STE 500 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972015537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666176855 | ||||||||
| FaxNumber: | 5033468015 | ||||||||
| Practice Location | |||||||||
| Address1: | 2214 LLOYD CTR | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972321311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034944222 | ||||||||
| FaxNumber: | 5034946143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2022 | ||||||||
| LastUpdateDate: | 10/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 22-QMHP-R-1592 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.