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NPI Code Detail

MEDICARE: DR. JOANNA MARIE CULLINS PSYD.

MEDICARE: DR. JOANNA MARIE CULLINS PSYD.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPY60482905WA
2103TC0700XClinical Psychologist2393OR

General Provider Information

NPI Number : 1164648895
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOANNA MARIE CULLINS PSYD.
Provider Business Mailing Address
First Line : 3300 MAIN ST UNIT 111
Second Line :
City : FOREST GROVE
State : OR
Zip : 97116-3240
Country : US
Telephone Number : 503-894-2725
Fax Number : 360-325-4358
Provider Business Practice Location Address
First Line : 4400 NE 77TH AVE STE 275
Second Line :
City : VANCOUVER
State : WA
Zip : 98662-6857
Country : US
Telephone Number : 503-894-2725
Fax Number : 360-326-2255
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 03/04/2021

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