Provider Demographics
NPI:1851054266
Name:BEHAVIORAL NEUROPSYCHOLOGY LLC
Entity Type:Organization
Organization Name:BEHAVIORAL NEUROPSYCHOLOGY LLC
Other - Org Name:BDTXPDX
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FULOP
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-539-4932
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty