Organization
CORVALLIS NEUROPSYCHOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIEN GUILLAUMOT PHD, MSCP, ABPP (MEMBER/MANAGER)
(541) 908-0223
Entity
Organization
Contact information
Practice address
408 SW MONROE AVE STE M210D, CORVALLIS, OR 97333-7228
(541) 216-4747
(541) 216-4772
Mailing address
408 SW MONROE AVE STE M210D, CORVALLIS, OR 97333-7228
(541) 216-4747
(541) 216-4772
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1683
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278211
—
OR
Enumeration date
03/29/2018
Last updated
08/15/2019
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