Individual
CHANEL BREAE DISMUKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1975 NW 167TH PL STE 100-42, BEAVERTON, OR 97006-4908
(503) 436-5663
Mailing address
1975 NW 167TH PL STE 100-42, BEAVERTON, OR 97006-4908
(503) 436-5663
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3292
OR
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
3292
OR
Other
Enumeration date
09/24/2015
Last updated
07/04/2024
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