Provider Demographics
NPI:1265751028
Name:MCNULTY, JAMES O (PSYD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:O
Last Name:MCNULTY
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 1:4905 SW SCHOLLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1605
Mailing Address - Country:US
Mailing Address - Phone:503-333-7205
Mailing Address - Fax:
Practice Address - Street 1:4905 SW SCHOLS FRY RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1605
Practice Address - Country:US
Practice Address - Phone:503-333-7205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0674106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist