Individual
ERIC WADE LYSNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC-R, CRM1
Contact information
Practice address
10564 SE WASHINGTON ST, PORTLAND, OR 97216-2809
(503) 228-9229
Mailing address
10564 SE WASHINGTON ST, PORTLAND, OR 97216-2809
(503) 228-9229
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-24-3638
OR
Other
Enumeration date
10/23/2024
Last updated
10/23/2024
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