Healthcare Provider Details

I. General information

NPI: 1134312697
Provider Name (Legal Business Name): LYSETTE HERRERA LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2007
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18765 SW BOONES FERRY RD STE 100
TUALATIN OR
97062-8607
US

IV. Provider business mailing address

18765 SW BOONES FERRY RD STE 100
TUALATIN OR
97062-8607
US

V. Phone/Fax

Practice location:
  • Phone: 503-612-1000
  • Fax: 503-612-1090
Mailing address:
  • Phone: 503-612-1000
  • Fax: 503-612-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60401264
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004125
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC3246
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: