Provider Demographics
NPI:1801231840
Name:STELL, MARY LILLIAN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LILLIAN
Last Name:STELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9830 NE CASCADES PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-6834
Mailing Address - Country:US
Mailing Address - Phone:503-239-8101
Mailing Address - Fax:503-408-5021
Practice Address - Street 1:9830 NE CASCADES PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-6834
Practice Address - Country:US
Practice Address - Phone:503-239-8101
Practice Address - Fax:503-408-5021
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORM5714104100000X
101YM0800X, 104100000X, 101Y00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORM5714OtherSTATE OF OREGON SOCIAL WORK