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1295575454
LARISSA LARA
PORTLAND, OR
NPI
1295575454
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Entity Type
Individual
Gender
N/A
Sole Proprietor ?
Yes
Primary Taxonomy
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)
Enumeration Date
2024-05-27
Last Update Date
2024-05-27
Business Address
LARISSA LARA
3415 SE POWELL BLVD
PORTLAND, OR 97202-3371
Phone number: 888-295-6996
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Mailing Address
LARISSA LARA
3415 SE POWELL BLVD
PORTLAND, OR 97202-3371
Phone number:
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