Healthcare Provider Details

I. General information

NPI: 1922436096
Provider Name (Legal Business Name): SCULLY VUE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2013
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5240 NE ELAM YOUNG PKWY STE 150
HILLSBORO OR
97124
US

IV. Provider business mailing address

5240 NE ELAM YOUNG PKWY STE 150
HILLSBORO OR
97124-6210
US

V. Phone/Fax

Practice location:
  • Phone: 503-846-4528
  • Fax:
Mailing address:
  • Phone: 503-846-4528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: