Provider Demographics
NPI:1114361243
Name:BELL, LARA A (QMHP)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:A
Last Name:BELL
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 NE DIVISION ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-4617
Mailing Address - Country:US
Mailing Address - Phone:503-666-3808
Mailing Address - Fax:503-666-6835
Practice Address - Street 1:4101 NE DIVISION ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-4617
Practice Address - Country:US
Practice Address - Phone:503-666-3808
Practice Address - Fax:503-666-6835
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health