Individual
LISA LYNN VESELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1122 NE 122ND AVE STE A200, PORTLAND, OR 97230-2083
(503) 594-4750
(971) 888-4607
Mailing address
1335 NW 23RD AVE APT 105, PORTLAND, OR 97210-2687
(503) 960-1025
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T20163
OR
Other
Enumeration date
10/02/2020
Last updated
10/02/2020
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