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General NPI Number Information
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NPI Number | 1366466732
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Entity Type | Individual
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Provider Name | KATHRYN MAE NUNLEY QMHP
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 400 NE 7TH ST
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City | GRESHAM
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State | OR
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Zip | 97030-5604
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Country | US
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Telephone | 503-489-2243
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Fax | 503-661-4959
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Provider Business Mailing Address
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Address Line | 3715 SE DORA CT
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City | TROUTDALE
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State | OR
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Zip | 97060-2514
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Country | US
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Telephone | 503-492-8288
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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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