| Mentor Professional Corporation | |
|
818 Nw 17th Ave # 11 Portland OR 97209-2327 | |
| (503) 227-2027 | |
| (503) 227-3836 |
| Full Name | Mentor Professional Corporation |
|---|---|
| Speciality | Psychologist |
| Location | 818 Nw 17th Ave # 11, Portland, Oregon |
| Authorized Official Name and Position | Michaele P. Dunlap (PRESIDENT) |
| Authorized Official Contact | 5032272027 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mentor Professional Corporation 818 Nw 17th Ave # 11 Portland OR 97209-2327 Ph: (503) 227-2027 | Mentor Professional Corporation 818 Nw 17th Ave # 11 Portland OR 97209-2327 Ph: (503) 227-2027 |
| NPI Number | 1881813004 |
|---|---|
| Provider Enumeration Date | 04/25/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2567451727 |
|---|---|
| Medicare Enrollment ID | O20180412000680 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881813004 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 0947 (Oregon) | Primary |
| Provider Name | Michaele Palmer Dunlap |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932326584 PECOS PAC ID: 8628169638 Enrollment ID: I20180412000735 |
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