Individual
AMY MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LOTR
Contact information
Practice address
4640 S MACADAM AVE STE 90, PORTLAND, OR 97239-4285
(503) 292-0765
Mailing address
5424 NE 41ST AVE, PORTLAND, OR 97211-8045
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
225X00000X
Occupational Therapist
Primary
402335
OR
Other
Enumeration date
12/09/2019
Last updated
02/27/2025
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