Basic Information
| Provider Information | |||||||||
| NPI: | 1639495989 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANNON | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC, LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4734 N MISSISSIPPI AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972173141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039154654 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9450 SW BARNES RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032162290 | ||||||||
| FaxNumber: | 5032165529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2010 | ||||||||
| LastUpdateDate: | 08/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C3804 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | LH 60455799 | WA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.