Provider Demographics
NPI:1518132562
Name:LANSING, MARY M (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:M
Last Name:LANSING
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 SW DOLPH CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3962
Mailing Address - Country:US
Mailing Address - Phone:503-293-2259
Mailing Address - Fax:503-293-2258
Practice Address - Street 1:2920 SW DOLPH CT
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3962
Practice Address - Country:US
Practice Address - Phone:503-293-2259
Practice Address - Fax:503-293-2258
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0157106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist