Mentor Professional Corporation in Portland - Clinical
Mentor Professional Corporation - NPI 1881813004
Mentor Professional Corporation is a Clinical in Portland, Oregon. Mentor Professional Corporation practices all healthcare services and medical treatments related to Clinical. The NPI Number for Mentor Professional Corporation is 1881813004. The last update date is 2020-08-22.
Mentor Professional Corporation's current location address is 818 Nw 17th Ave # 11, Portland, Oregon. You can contact this provider via phone number 5032272027 and fax number 5032273836. The mailing address for Mentor Professional Corporation is 818 Nw 17th Ave # 11, Portland, Oregon. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Mentor Professional Corporation |
|---|---|
| Address | 818 Nw 17th Ave # 11, Portland, Oregon |
| Phone Number | 5032272027 |
| Fax Number | 5032273836 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | PRESIDENT |
|---|---|
| Authorized Official Name | Dunlap P. Michaele |
| Credentials | PSY.D. |
| Telephone Number | 5032272027 |
NPI Number Detail
| NPI Number | 1881813004 |
|---|---|
| Provider Enumeration Date | 2007-04-25 |
| Last Updated Date | 2020-08-22 |
Provider Mailing Address Detail
| Address | 818 Nw 17th Ave # 11 |
|---|---|
| City | Portland |
| State | Oregon (OR) |
| Post Code | 972092327 |
| Phone Number | 5032272027 |
| Fax Number | 5032273836 |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 103Tc0700X |
| Licence No | 947 |
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Definition: A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in |
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What is the Mentor Professional Corporation's unique identification number?
The Mentor Professional Corporation has been assigned the NPI (National Provider Identifier) Number 1881813004 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for the organization.
Could you share the physical location details of Mentor Professional Corporation?
The Mentor Professional Corporation is situated at 818 Nw 17Th Ave # 11, in the city of Portland, state of OR, with the zip code 972092327.
What is the Mentor Professional Corporation's specialty and taxonomy code?
The Mentor Professional Corporation's specialty is Clinical, and the corresponding taxonomy code is 103Tc0700X.
On what date did the Mentor Professional Corporation receive its 1881813004 assignment from the Centers for Medicare & Medicaid Services?
The Mentor Professional Corporation was assigned its 1881813004 by the Centers for Medicare & Medicaid Services on 2007-04-25.
When was the information pertaining to Mentor Professional Corporation most recently updated or revised?
The details related to Mentor Professional Corporation, including its address, specialty, and other relevant information, were last updated or revised on 2020-08-22.
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