Healthcare Provider Details

I. General information

NPI: 1902464654
Provider Name (Legal Business Name): ADHD CHILD & FAMILY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9370 SW GREENBURG RD STE 413
TIGARD OR
97223-5427
US

IV. Provider business mailing address

9370 SW GREENBURG RD STE 413
PORTLAND OR
97223-5427
US

V. Phone/Fax

Practice location:
  • Phone: 971-302-7374
  • Fax:
Mailing address:
  • Phone: 971-302-7374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: LARA CANNON
Title or Position: OWNER, PRACTIONER
Credential: LPC
Phone: 971-302-7374