Provider Demographics
NPI:1548260268
Name:WILLEFORD, CAROL SHYCHY (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:SHYCHY
Last Name:WILLEFORD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1525 NE WEIDLER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1410
Mailing Address - Country:US
Mailing Address - Phone:503-525-1143
Mailing Address - Fax:503-287-0212
Practice Address - Street 1:1525 NE WEIDLER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1410
Practice Address - Country:US
Practice Address - Phone:503-525-1143
Practice Address - Fax:503-287-0212
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080044854N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health