Provider Demographics
NPI:1053605667
Name:WALLINGTON, ARIN ANN (MA MFT)
Entity type:Individual
Prefix:MRS
First Name:ARIN
Middle Name:ANN
Last Name:WALLINGTON
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:ARIN
Other - Middle Name:ANN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA MFT
Mailing Address - Street 1:4585 SW 185TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97078-1557
Mailing Address - Country:US
Mailing Address - Phone:503-591-9280
Mailing Address - Fax:503-619-1949
Practice Address - Street 1:4585 SW 185TH AVE
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97078-1557
Practice Address - Country:US
Practice Address - Phone:503-591-9280
Practice Address - Fax:503-619-1949
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR123190Medicaid