Individual
MS. MARY ELLEN MCGILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
2929 SW MULTNOMAH BLVD STE 104, PORTLAND, OR 97219-4070
(503) 771-1789
(503) 236-8381
Mailing address
2103 N FARRAGUT ST, PORTLAND, OR 97217-6422
(503) 286-2951
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C0984
OR
174400000X
Specialist
4395
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-1147680
EMPLOYEE ID #
OR
01
—
20-2040322
EMPLOYEE ID #
OR
Enumeration date
04/25/2007
Last updated
10/27/2008
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