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General NPI Number Information
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NPI Number | 1205265493
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Entity Type | Individual
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Provider Name | CHUNG-FAN NI PHD
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Gender | Female
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 182 S. W. ACADEMY ST. ACADEMY BUILDING
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City | DALLAS
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State | OR
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Zip | 97338
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Country | US
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Telephone | 503-623-2424
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Fax |
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Provider Business Mailing Address
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Address Line | 345 MONMOUTH AVE N
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City | MONMOUTH
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State | OR
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Zip | 97361-1329
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Country | US
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Telephone | 503-838-8038
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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