Individual
JENNIFER LOPEZ GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA-R
Contact information
Practice address
13317 SE POWELL BLVD, PORTLAND, OR 97236-3335
(503) 760-9606
Mailing address
3716 NE MLK BLVD, PORTLAND, OR 97212-1111
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/07/2022
Last updated
07/09/2023
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