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General NPI Number Information
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NPI Number | 1043677198
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Entity Type | Organization
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Legal Business Name | ANJULI SHAH-JOHNSON
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 1611 NE 16TH AVE
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City | PORTLAND
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State | OR
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Zip | 97232-1413
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Country | US
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Telephone | 773-991-0103
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Fax |
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Provider Business Mailing Address
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Address Line | 1611 NE 16TH AVE
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City | PORTLAND
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State | OR
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Zip | 97232-1413
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST/BODYWORKER
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Name | ANJULI SHAH-JOHNSON
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Credential |
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Telephone | 773-991-0103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | L5990
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License Number State | OR
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