Provider Demographics
NPI:1518392091
Name:MULIRO, SHANICE NICOLE
Entity Type:Individual
Prefix:
First Name:SHANICE
Middle Name:NICOLE
Last Name:MULIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 N FARRAGUT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-6519
Mailing Address - Country:US
Mailing Address - Phone:971-207-6578
Mailing Address - Fax:
Practice Address - Street 1:1841 N FARRAGUT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-6519
Practice Address - Country:US
Practice Address - Phone:971-207-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1925938101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health