Provider Demographics
NPI:1861249682
Name:MULLEN, JEAN SHERRY (STUDENT INTERN)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:SHERRY
Last Name:MULLEN
Suffix:
Gender:F
Credentials:STUDENT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 SW GREENBURG RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5502
Mailing Address - Country:US
Mailing Address - Phone:971-266-4759
Mailing Address - Fax:
Practice Address - Street 1:9900 SW GREENBURG RD STE 200
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5502
Practice Address - Country:US
Practice Address - Phone:971-260-9719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health