Individual
MRS. LARA CHRISTINE CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
9370 SW GREENBURG RD STE 413, TIGARD, OR 97223-5427
(971) 302-7374
Mailing address
3920 SW SHATTUCK RD, PORTLAND, OR 97221-3075
(503) 477-7895
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C5220
OR
Other
Enumeration date
09/23/2016
Last updated
06/11/2019
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