person
Jonathan Mychal Larson
Mental Health Counselor in Portland, Oregon
NPI 1619174117

Jonathan Mychal Larson is a Mental Health Counselor based in Portland, OR and is specialized in Mental Health. Jonathan Mychal Larson practices in Portland, OR. The NPI Number for Jonathan Mychal Larson is 1619174117 and holds a License No. (Oregon).

The current practice location address for Jonathan Mychal Larson is 3415 Se Powell Blvd, Portland, OR and can be reached out via phone at 503-234-9591 and via fax at 503-205-3552.

Location: 3415 Se Powell Blvd, Portland, OR, 97202-4545
person
Provider Profile Details
NPI Number
1619174117
Provider Name
Jonathan Mychal Larson
Credential
Provider Entity Type
Individual
Gender
Male
Address
3415 Se Powell Blvd, Portland, OR, 97202-4545
Phone Number
503-234-9591
Fax Number
503-205-3552
Provider Enumeration Date
06/28/2007
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
3415 Se Powell Blvd
City
State
Zip
97202-3371
Phone Number
503-234-9591
Fax Number
503-205-3552
person
Provider Business Mailing Address Details
Address
3415 Se Powell Blvd
City
State
Zip
97202-3371
Phone Number
503-234-9591
Fax Number
503-205-3552
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
(Oregon)
Definition
Definition to come...
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