Individual
LISA BRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
182 SW ACADEMY ST, DALLAS, OR 97338-1996
(503) 623-9289
Mailing address
1519 KELLY ST NE, KEIZER, OR 97303-2062
(503) 930-8345
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OR
Other
Enumeration date
04/27/2017
Last updated
10/22/2024
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