Individual
MS. MARY LISA GATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2800 N VANCOUVER AVE, SUITE 230, PORTLAND, OR 97227-1630
(503) 413-5161
(503) 413-4898
Mailing address
2800 N VANCOUVER AVE, SUITE 230, PORTLAND, OR 97227-1630
(503) 413-5161
(503) 413-4898
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L3461
OR
Other
Enumeration date
10/16/2013
Last updated
10/16/2013
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