Individual
MIRA LEE COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
THW, PSS
Contact information
Practice address
3231 SE 50TH AVE # 1831, PORTLAND, OR 97206-2248
(503) 238-5203
Mailing address
919 NE 47TH AVE APT 4, PORTLAND, OR 97213-2221
(503) 704-8403
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
108594
OR
Other
Enumeration date
03/24/2023
Last updated
03/24/2023
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