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NPI Code Detail

MEDICARE: JANELLE LISA BURKLUND QMHA

MEDICARE: JANELLE LISA BURKLUND QMHA
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1730228297
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANELLE LISA BURKLUND QMHA
Provider Business Mailing Address
First Line : PO BOX 8459
Second Line :
City : PORTLAND
State : OR
Zip : 97207-8459
Country : US
Telephone Number : 503-771-6061
Fax Number :
Provider Business Practice Location Address
First Line : 7511 SE HENRY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97206-6445
Country : US
Telephone Number : 503-771-7061
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 04/18/2008

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