Individual
MRS. KELLY C GRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
959 SE DIVISION ST STE 520, PORTLAND, OR 97214-4672
(503) 549-4714
Mailing address
PO BOX 90309, PORTLAND, OR 97290-0309
(618) 339-7497
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
106H00000X
Marriage & Family Therapist
LF61139306
WA
106H00000X
Marriage & Family Therapist
Primary
T1439
OR
Other
Enumeration date
01/08/2016
Last updated
08/02/2023
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