Provider Demographics
NPI:1427778026
Name:LARSON, ERIKA LESLIE (QMHP-R)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:LESLIE
Last Name:LARSON
Suffix:
Gender:F
Credentials:QMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 SW OAK ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1810
Mailing Address - Country:US
Mailing Address - Phone:503-988-5464
Mailing Address - Fax:
Practice Address - Street 1:2951 NW DIVISION ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5292
Practice Address - Country:US
Practice Address - Phone:503-215-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health