Individual
ALYSSA ANNE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHP
Contact information
Practice address
2375 NW GLISAN ST, PORTLAND, OR 97210-3420
(503) 243-2236
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
372600000X
Adult Companion
—
—
Other
Enumeration date
08/06/2012
Last updated
09/30/2013
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