Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2405 | OR |
Y | 103T00000X | Psychologist | 2405 | OR |
N | 103TC1900X | Counseling Psychologist | 2405 | OR |
NPI | 1114490620 |
---|---|
Provider Name | Lynn Kulander Collins |
First Address | Portland, OR 97239-3822 |
Second Address | Portland, OR 97239-3822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2019 |
Last Update Date | 07/01/2019 |