Healthcare Provider Details

I. General information

NPI: 1023330404
Provider Name (Legal Business Name): LARGOLEE YULAN HUANG-STORMS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LARK HUANG-STORMS

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-2067
  • Fax:
Mailing address:
  • Phone: 503-494-2067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34280
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2288
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: