Provider Demographics
NPI:1891003711
Name:POPE, MARY WELLS (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY WELLS
Middle Name:
Last Name:POPE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 NE 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-4814
Mailing Address - Country:US
Mailing Address - Phone:503-467-1790
Mailing Address - Fax:
Practice Address - Street 1:2100 NE BROADWAY
Practice Address - Street 2:SUITE 335
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1570
Practice Address - Country:US
Practice Address - Phone:503-467-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC4951101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor