Provider Demographics
NPI:1467993220
Name:LLANES, IRMA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:LLANES
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 1:7155 SW VARNS ST STE 211
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8175
Mailing Address - Country:US
Mailing Address - Phone:503-332-3394
Mailing Address - Fax:
Practice Address - Street 1:7155 SW VARNS ST
Practice Address - Street 2:211
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8174
Practice Address - Country:US
Practice Address - Phone:503-332-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4419101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health