Individual
SHELLY LYNN MCMULLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA QMHA
Contact information
Practice address
412 SW 12TH AVE, PORTLAND, OR 97205-2329
(503) 803-7624
(503) 944-2595
Mailing address
1942 SE 30TH AVE APT A, PORTLAND, OR 97214-4900
(503) 816-5449
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/22/2007
Last updated
07/08/2007
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