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General NPI Number Information
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NPI Number | 1366658130
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Entity Type | Organization
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Legal Business Name | LARRY CONNER MA LPC PC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2304 E BURNSIDE ST STE 106
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City | PORTLAND
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State | OR
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Zip | 97214-1689
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Country | US
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Telephone | 503-252-1050
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Fax |
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Provider Business Mailing Address
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Address Line | 6615 N CURTIS AVE
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City | PORTLAND
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State | OR
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Zip | 97217-4061
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Country | US
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Telephone | 503-525-1050
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LAWRENCE S. CONNER
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Credential | MA LPC
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Telephone | 503-525-1050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C0099
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License Number State | OR
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