Individual
MS. LAURA JO PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.F.T.
Contact information
Practice address
2311 E. BURNSIDE ST., STE 102, PORTLAND, OR 97214
(503) 388-8898
(209) 956-4245
Mailing address
P.O. BOX 2046, PORTLAND, OR 97208
(503) 388-8898
(209) 956-4245
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
IMF 39359
CA
106H00000X
Marriage & Family Therapist
Primary
T0702
OR
Other
Enumeration date
04/10/2007
Last updated
01/06/2015
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