Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1690 | OR |
NPI | 1043352289 |
---|---|
Provider Name | Roberta L Mihara |
First Address | Portland, OR 97213-4510 |
Second Address | Portland, OR 97213-4510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 20/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
028298 | (05) | OR |