Individual provider · Type 1 NPI

Jonathan Mychal Larson

Mental Health Counselor · Portland, OR

NPI number 1619174117 Active

Practice location

3415 SE Powell Blvd
Portland, OR 97202-3371

Call (503) 234-9591 Map

Fax (503) 205-3552

Mailing address

2945 SE Steele St Apt 108
Portland, OR 97202-4545

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

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About NPI 1619174117

Jonathan Mychal Larson's National Provider Identifier is 1619174117, issued on Jun 28, 2007. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Portland, OR. The record was last updated on Jul 8, 2007.