Provider Demographics
NPI:1558170027
Name:CORLISS, LINDSAY (MA)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:CORLISS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 NE 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4421
Mailing Address - Country:US
Mailing Address - Phone:503-750-6670
Mailing Address - Fax:
Practice Address - Street 1:10000 NE 7TH AVE STE 403
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-4548
Practice Address - Country:US
Practice Address - Phone:360-952-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health