Healthcare Provider Details

I. General information

NPI: 1427778026
Provider Name (Legal Business Name): ERIKA LESLIE LARSON QMHP-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 NW DIVISION ST
GRESHAM OR
97030-5292
US

IV. Provider business mailing address

421 SW OAK ST STE 520
PORTLAND OR
97204-1810
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-9500
  • Fax:
Mailing address:
  • Phone: 503-988-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: