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Masyn Kathleen Clark

Individual provider Active NPI Marriage & Family Therapist · Beaverton, OR

NPI 1497326128 · NPPES record last updated Mar 19, 2024

Key facts

NPI
1497326128
Entity type
Individual (NPI type 1)
Primary specialty
Marriage & Family Therapist 106H00000X
Practice address
10700 SW Beaverton Hillsdale Hwy Ste 696-1
Beaverton, OR 97005-3019
Phone
(503) 939-6425
NPI assigned
Jul 3, 2021
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
A391223ORMDBehavior Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Brigette Keane Counseling, LLC Marriage & Family Therapist Past
since Sep 15, 2024		 Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X A391223 OR
Marriage & Family Therapist 106H00000X Yes

Addresses

Primary practice location

10700 SW Beaverton Hillsdale Hwy Ste 696-1
Beaverton, OR 97005-3019

Mailing address

21600 Oxnard St Ste 1800
Woodland Hills, CA 91367-7807

Other practice location 1

3709 Citation Way
Medford, OR 97504-9022
Phone (541) 500-6532

Other providers in Beaverton, OR

All providers in Beaverton, OR · Marriage & Family Therapist in Oregon

Sources for this page

Verify at the official NPI Registry.