Provider Demographics
NPI:1639495989
Name:MANNON, JULIE (LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MANNON
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4734 N MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-3141
Mailing Address - Country:US
Mailing Address - Phone:503-915-4654
Mailing Address - Fax:
Practice Address - Street 1:9450 SW BARNES RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6619
Practice Address - Country:US
Practice Address - Phone:503-216-2290
Practice Address - Fax:503-216-5529
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3804101YM0800X
WALH 60455799101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health