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General NPI Number Information
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NPI Number | 1881813004
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Entity Type | Organization
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Legal Business Name | MENTOR PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 818 NW 17TH AVE # 11
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City | PORTLAND
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State | OR
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Zip | 97209-2327
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Country | US
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Telephone | 503-227-2027
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Fax | 503-227-3836
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Provider Business Mailing Address
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Address Line | 818 NW 17TH AVE # 11
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City | PORTLAND
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State | OR
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Zip | 97209-2327
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Country | US
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Telephone | 503-227-2027
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Fax | 503-227-3836
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAELE P. DUNLAP
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Credential | PSY.D.
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Telephone | 503-227-2027
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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 | 0947
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License Number State | OR
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