JONATHAN MYCHAL LARSON

PORTLAND, OR
NPI1619174117
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: OR  930386966)
Enumeration Date2007-06-28
Last Update Date2007-07-08
Business Address
-- JONATHAN MYCHAL LARSON
3415 SE POWELL BLVD
PORTLAND, OR 97202-3371
Phone number: 503-234-9591
Mailing Address
-- JONATHAN MYCHAL LARSON
2945 SE STEELE ST APT 108
PORTLAND, OR 97202-4545
Phone number: 541-490-5382
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