Provider Demographics
NPI:1245382456
Name:FULOP, MICHAEL J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:FULOP
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 SW JEFFERSON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-7711
Mailing Address - Country:US
Mailing Address - Phone:503-539-4932
Mailing Address - Fax:503-297-5744
Practice Address - Street 1:2130 SW JEFFERSON ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-7711
Practice Address - Country:US
Practice Address - Phone:503-539-4932
Practice Address - Fax:503-297-5744
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1049103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty