Individual provider · Type 1 NPI

Larston Petticord, MS, LPC

Mental Health Counselor · Portland, OR

NPI number 1871889261 Active

Practice location

3419 NE Sandy Blvd
Portland, OR 97232-1959

Mailing address

11626 NE Everett St
Portland, OR 97220-2362

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1871889261

Larston Petticord, MS, LPC's National Provider Identifier is 1871889261, issued on Jun 23, 2011. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Portland, OR. The record was last updated on Oct 2, 2019.