Individual
DAVID IXTLAHUAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
1110 SE ALDER ST STE 301, PORTLAND, OR 97214-2400
(971) 303-8243
Mailing address
3705 N OVERLOOK BLVD APT 311, PORTLAND, OR 97227-2036
(971) 303-8243
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
T1543
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T1543
OBLPCT
OR
Enumeration date
04/12/2018
Last updated
03/03/2020
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