Individual
LARISSA LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(888) 295-6996
Mailing address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/27/2024
Last updated
05/27/2024
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