| Bdtxpdx | |
|
2130 Sw Jefferson St Ste 300 Portland OR 97201-7711 | |
| (503) 539-4932 | |
| (503) 297-5744 |
| Full Name | Bdtxpdx |
|---|---|
| Speciality | Psychologist - Clinical Child & Adolescent |
| Location | 2130 Sw Jefferson St Ste 300, Portland, Oregon |
| Authorized Official Name and Position | Michael J Fulop (OWNER) |
| Authorized Official Contact | 5035394932 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bdtxpdx 2130 Sw Jefferson St Ste 300 Portland OR 97201-7711 Ph: (503) 539-4932 | Bdtxpdx 2130 Sw Jefferson St Ste 300 Portland OR 97201-7711 Ph: (503) 539-4932 |
| NPI Number | 1851054266 |
|---|---|
| Provider Enumeration Date | 10/21/2021 |
| Last Update Date | 12/07/2022 |
| Certification Date | 08/31/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851054266 | NPI | - | NPPES |
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