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1427779016
TYSCHAL LUMBREA BLAKE
PORTLAND, OR
NPI
1427779016
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101Y00000X Counselor
Additional Taxonomies
106S00000X Behavior Technician
Enumeration Date
2022-09-12
Last Update Date
2023-09-18
Business Address
TYSCHAL LUMBREA BLAKE
1904 SE DIVISION ST
PORTLAND, OR 97202-1146
Phone number: 503-517-8663
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Mailing Address
TYSCHAL LUMBREA BLAKE
1904 SE DIVISION ST
PORTLAND, OR 97202-1146
Phone number: 503-704-1350
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