Individual
MRS. ELIZABETH FRANCES WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
6360 SW MERLIN CT, PORTLAND, OR 97219-4942
(503) 317-2498
Mailing address
6360 SW MERLIN CT, PORTLAND, OR 97219-4942
(503) 317-2498
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C2083
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
Enumeration date
05/21/2008
Last updated
12/04/2021
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