Provider Demographics
NPI:1801361761
Name:LAWRENCE, ALEXIS BOBBETTE (CSWA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:BOBBETTE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5254 NE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6216
Mailing Address - Country:US
Mailing Address - Phone:503-475-6424
Mailing Address - Fax:
Practice Address - Street 1:209 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1813
Practice Address - Country:US
Practice Address - Phone:503-823-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORA5716101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health