Provider Demographics
NPI:1871102400
Name:AKMAZO LLC
Entity type:Organization
Organization Name:AKMAZO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELENI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZAROU
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:517-488-5059
Mailing Address - Street 1:1720 NW LOVEJOY ST STE 302
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2344
Mailing Address - Country:US
Mailing Address - Phone:517-488-5059
Mailing Address - Fax:
Practice Address - Street 1:1720 NW LOVEJOY ST STE 302
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2344
Practice Address - Country:US
Practice Address - Phone:517-488-5059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500810343Medicaid
OR500764725Medicaid