Healthcare Provider Details

I. General information

NPI: 1528987088
Provider Name (Legal Business Name): LISA HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NE HOOD AVE STE 310L
GRESHAM OR
97030-7303
US

IV. Provider business mailing address

501 NE HOOD AVE STE 310L
GRESHAM OR
97030-7303
US

V. Phone/Fax

Practice location:
  • Phone: 503-208-5288
  • Fax: 503-405-4239
Mailing address:
  • Phone: 503-208-5288
  • Fax: 503-405-4239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: