| Corvallis Neuropsychology Llc | |
|
408 Sw Monroe Ave Ste M210d Corvallis OR 97333-7228 | |
| (541) 216-4747 | |
| (541) 216-4772 |
| Full Name | Corvallis Neuropsychology Llc |
|---|---|
| Speciality | Psychologist |
| Location | 408 Sw Monroe Ave Ste M210d, Corvallis, Oregon |
| Authorized Official Name and Position | Julien Guillaumot (MEMBER/MANAGER) |
| Authorized Official Contact | 5419080223 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Corvallis Neuropsychology Llc 408 Sw Monroe Ave Ste M210d Corvallis OR 97333-7228 Ph: (541) 216-4747 | Corvallis Neuropsychology Llc 408 Sw Monroe Ave Ste M210d Corvallis OR 97333-7228 Ph: (541) 216-4747 |
| NPI Number | 1174028294 |
|---|---|
| Provider Enumeration Date | 03/29/2018 |
| Last Update Date | 08/15/2019 |
| Medicare PECOS PAC ID | 2163777871 |
|---|---|
| Medicare Enrollment ID | O20180621001117 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174028294 | NPI | - | NPPES |
| 278211 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 1683 (Oregon) | Primary |
| Provider Name | Julien Guillaumot |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124079066 PECOS PAC ID: 3870516222 Enrollment ID: I20060111000796 |
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