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General NPI Number Information
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NPI Number | 1700319803
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Entity Type | Organization
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Legal Business Name | ANNIE MUNSON-PHELPS, LLC
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 1135 SE SALMON ST #102
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City | PORTLAND
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State | OR
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Zip | 97214-3375
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Country | US
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Telephone | 503-956-8907
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Fax |
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Provider Business Mailing Address
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Address Line | 5603 SE 54TH AVE
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City | PORTLAND
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State | OR
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Zip | 97206-5661
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Country | US
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Telephone | 503-956-8907
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | MS. ANNE MUNSON-PHELPS
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Credential | LMFT
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Telephone | 503-956-8907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T1254
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License Number State | OR
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