Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003178476 |
---|---|
Provider Name | Debra Agee |
First Address | Portland, OR 97207-8459 |
Second Address | Wilsonville, OR 97070-7383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2012 |
Last Update Date | 29/07/2013 |