Individual
ABBIE SISOUPHANH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CRC
Contact information
Practice address
4531 SE BELMONT ST, PORTLAND, OR 97215-1699
(000) 000-0000
Mailing address
4531 SE BELMONT ST STE 315, PORTLAND, OR 97215-1675
(503) 317-6802
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
R9891
OR
Other
Enumeration date
07/09/2024
Last updated
09/18/2024
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