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General NPI Number Information
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NPI Number | 1164648895
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Entity Type | Individual
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Provider Name | JOANNA MARIE CULLINS PSYD.
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 4400 NE 77TH AVE STE 275
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City | VANCOUVER
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State | WA
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Zip | 98662-6857
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Country | US
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Telephone | 503-894-2725
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Fax | 360-326-2255
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Provider Business Mailing Address
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Address Line | 3300 MAIN ST UNIT 111
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City | FOREST GROVE
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State | OR
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Zip | 97116-3240
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Country | US
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Telephone | 503-894-2725
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Fax | 360-325-4358
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY60482905
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2393
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License Number State | OR
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