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General NPI Number Information
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NPI Number | 1851054266
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL NEUROPSYCHOLOGY LLC
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Dates
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Enumeration Date | 10/21/2021
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 2130 SW JEFFERSON ST STE 300
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City | PORTLAND
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State | OR
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Zip | 97201-7711
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Country | US
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Telephone | 503-539-4932
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Fax | 503-297-5744
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Provider Business Mailing Address
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Address Line | 2130 SW JEFFERSON ST STE 300
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City | PORTLAND
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State | OR
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Zip | 97201-7711
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Country | US
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Telephone | 503-539-4932
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Fax | 503-297-5744
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL J FULOP
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Credential | PSYD
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Telephone | 503-539-4932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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