Provider Demographics
NPI:1093426660
Name:ARMIJO, ANGELICA LEE
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:LEE
Last Name:ARMIJO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ANGELUS
Other - Middle Name:LEE
Other - Last Name:ARMIJO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3415 SE POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3371
Mailing Address - Country:US
Mailing Address - Phone:503-234-9591
Mailing Address - Fax:
Practice Address - Street 1:3415 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3371
Practice Address - Country:US
Practice Address - Phone:503-234-9591
Practice Address - Fax:503-205-0190
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2025-03-31
Deactivation Date:2025-03-18
Deactivation Code:
Reactivation Date:2025-03-24
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health