Provider Demographics
NPI:1700319803
Name:ANNIE MUNSON-PHELPS, LLC
Entity Type:Organization
Organization Name:ANNIE MUNSON-PHELPS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNSON-PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:503-956-8907
Mailing Address - Street 1:5603 SE 54TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5661
Mailing Address - Country:US
Mailing Address - Phone:503-956-8907
Mailing Address - Fax:
Practice Address - Street 1:1135 SE SALMON ST
Practice Address - Street 2:#102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3375
Practice Address - Country:US
Practice Address - Phone:503-956-8907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1254106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty