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Organization
MENTAL HEALTH & ADDICTION THERAPY, LLC
Active
Organization
MENTAL HEALTH & ADDICTION THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NIAZ LARSEN LPC, CADC (MENTAL HEALTH & ADDICTION THERAPIST)
(503) 804-1467
Entity
Organization
Contact information
Practice address
511 SW 10TH AVE STE 601, PORTLAND, OR 97205-2707
(503) 597-8250
Mailing address
4654 N VANCOUVER AVE, PORTLAND, OR 97217-2946
(503) 804-1467
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11-03-20
OR
101YM0800X
Mental Health Counselor
Primary
C2855
OR
Other
Enumeration date
03/09/2017
Last updated
03/18/2017
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