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General NPI Number Information
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NPI Number | 1750936373
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Entity Type | Organization
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Legal Business Name | M. HUNDLEY SUBER, LLC
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Dates
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Enumeration Date | 08/09/2019
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Last Update Date | 04/13/2024
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Provider Practice Location Address
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Address Line | 4039 N MISSISSIPPI AVE STE 309
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City | PORTLAND
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State | OR
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Zip | 97227-1477
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Country | US
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Telephone | 971-232-3412
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Fax | 971-203-7302
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Provider Business Mailing Address
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Address Line | 4039 N MISSISSIPPI AVE STE 309
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City | PORTLAND
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State | OR
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Zip | 97227-1477
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Country | US
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Telephone | 971-232-3412
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Fax | 971-203-7302
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. MARION HUNDLEY SUBER
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Credential | PSYD
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Telephone | 971-232-3412
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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 |
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License Number State |
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