Individual
MS. LARA BISSONNETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1551 OAK ST STE D, EUGENE, OR 97401-4023
(541) 521-9891
Mailing address
2852 WILLAMETTE ST # 404, EUGENE, OR 97405-8200
(541) 359-9851
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
R4522
OR
101YM0800X
Mental Health Counselor
T1926
—
106H00000X
Marriage & Family Therapist
R4522
OR
106H00000X
Marriage & Family Therapist
Primary
T1926
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R4522
OREGON BOARD OFLICENSED PROFESSIONAL CONSELORS
OR
Enumeration date
01/17/2020
Last updated
09/08/2021
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