Individual
ELISIA LOPEZ-MENDIOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, QMHP
Contact information
Practice address
12121 E BURNSIDE ST, PORTLAND, OR 97216-3737
(971) 361-7764
Mailing address
12121 E BURNSIDE ST, PORTLAND, OR 97216-3737
(971) 361-7764
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
L8223
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/21/2010
Last updated
09/17/2019
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