Provider Demographics
NPI:1003133125
Name:MITCHELL, LISA ADAIR (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ADAIR
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7180 SW FIR LOOP,
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8023
Mailing Address - Country:US
Mailing Address - Phone:503-214-2645
Mailing Address - Fax:503-620-3453
Practice Address - Street 1:7180 SW FIR LOOP,
Practice Address - Street 2:SUITE 1-A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8023
Practice Address - Country:US
Practice Address - Phone:503-214-2645
Practice Address - Fax:503-620-3453
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1243101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional