Healthcare Provider Details

I. General information

NPI: 1215214978
Provider Name (Legal Business Name): LISA MARIE OBRIEN MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NE BROADWAY ST SUITE 323
PORTLAND OR
97232-1569
US

IV. Provider business mailing address

6945 NE 13TH AVE
PORTLAND OR
97211-4022
US

V. Phone/Fax

Practice location:
  • Phone: 503-915-1082
  • Fax:
Mailing address:
  • Phone: 503-333-9301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC3672
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: