Healthcare Provider Details

I. General information

NPI: 1770452286
Provider Name (Legal Business Name): BETH ANNE FOX NUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 SE SUNNYSIDE RD STE 480
CLACKAMAS OR
97015-5705
US

IV. Provider business mailing address

14231 S MACKSBURG RD
MOLALLA OR
97038-8402
US

V. Phone/Fax

Practice location:
  • Phone: 503-739-8321
  • Fax: 971-209-7172
Mailing address:
  • Phone: 503-913-9598
  • Fax: 503-913-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR9361
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: