Individual
ELISSA KATHLEEN MANTALAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
2410 SE 121ST AVE STE 216, PORTLAND, OR 97216-4085
(971) 570-4721
Mailing address
2410 SE 121ST AVE STE 216, PORTLAND, OR 97216-4085
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/10/2007
Last updated
12/10/2007
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