Individual
LORI DENISE MATTHEWS-KUMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
847 NE 19TH AVE STE 100, PORTLAND, OR 97232-2684
(503) 238-0769
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
(541) 684-4156
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500663798
—
OR
Enumeration date
03/13/2007
Last updated
07/23/2019
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