Most Relevant Information
Provider Data
| NPI Number: | 1003244740 |
| Provider Name: | MARY LISA GATES LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | L3461 |
Most Important Dates
| Enumeration Date: | 10/16/2013 |
| Last Updated: | 10/16/2013 |
Provider Practice Location
2800 N VANCOUVER AVE
SUITE 230
PORTLAND
OR
972271630
Practice Location Phone/Fax
| Phone: | 5034135161 |
| Fax: | 5034134898 |
Provider Mailing Location
2800 N VANCOUVER AVE
SUITE 230
PORTLAND
OR
972271630
Provider Mailing Phone/Fax
| Phone: | 5034135161 |
| Fax: | 5034134898 |