Individual
LUSIJAH MARX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD, PMHNP, RN
Contact information
Practice address
2901 E BURNSIDE ST, PORTLAND, OR 97214-1831
(503) 238-5203
(503) 238-5202
Mailing address
2901 E BURNSIDE ST, PORTLAND, OR 97214-1831
(503) 238-5203
(503) 238-5202
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
964
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
298940
—
OR
Enumeration date
02/13/2007
Last updated
07/09/2007
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