Provider Demographics
NPI:1902144777
Name:LARSEN SANCHEZ, ADRIAN (PSYD)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:
Last Name:LARSEN SANCHEZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:EDGAR
Other - Middle Name:ADRIAN
Other - Last Name:SANCHEZ MALFAVON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3050 SE DIVISION ST STE 215
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1451
Mailing Address - Country:US
Mailing Address - Phone:503-451-5041
Mailing Address - Fax:503-715-5469
Practice Address - Street 1:3050 SE DIVISION STREET SUITE 215
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1451
Practice Address - Country:US
Practice Address - Phone:503-451-5041
Practice Address - Fax:503-715-5469
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2623103TC0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical