Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | R3455 | OR |
NPI | 1003290669 |
---|---|
Provider Name | Anna Cullop |
First Address | Portland, OR 97214 |
Second Address | Portland, OR 97214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2015 |
Last Update Date | 14/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
339910 | NCC CERTIFICATION NUMBER (01) | OR |
R3455 | OBLPCT REGISTRATION NUMBER (01) | OR |