Provider Demographics
NPI:1720377088
Name:AASHEIM, LISA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:AASHEIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8737 SW 184TH DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6865
Mailing Address - Country:US
Mailing Address - Phone:503-804-3815
Mailing Address - Fax:
Practice Address - Street 1:615 SW HARRISON ST # 715
Practice Address - Street 2:SPED/COUN, PORTLAND STATE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-3548
Practice Address - Country:US
Practice Address - Phone:503-804-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2610101YM0800X
WALH60171272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health