Individual
PERCIVAL ALIOTH LIEBAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
30 NE MARTIN LUTHER KING JR BLVD, PORTLAND, OR 97232-2941
(503) 232-1099
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
—
—
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
11/28/2017
Last updated
10/27/2023
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