Provider Demographics
NPI:1619185501
Name:HEBERLEIN, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HEBERLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 SW WHISPER CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5010
Mailing Address - Country:US
Mailing Address - Phone:503-502-3505
Mailing Address - Fax:
Practice Address - Street 1:1730 SW SKYLINE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2537
Practice Address - Country:US
Practice Address - Phone:503-502-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist