Individual
MARY HERIZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4431 SE WOODSTOCK BLVD, PORTLAND, OR 97206-6271
(503) 490-4040
Mailing address
7627 SE ELLIS ST, PORTLAND, OR 97206-5105
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C5409
OR
Other
Enumeration date
10/09/2019
Last updated
10/09/2019
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