Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003154279 |
---|---|
Provider Name | Ellise D Parr |
First Address | Portland, OR 97202-4343 |
Second Address | Oregon City, OR 97045-9490 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2013 |
Last Update Date | 23/01/2013 |