Individual
OMOLOLA ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1312 E BURNSIDE ST, PORTLAND, OR 97214-1424
(503) 205-1669
Mailing address
3439 NE SANDY BLVD, SUITE 216, PORTLAND, OR 97232-1959
(503) 205-1669
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
L7113
OR
Other
Enumeration date
03/03/2017
Last updated
03/03/2017
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