Corvallis Neuropsychology LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1683 Issued in OR

Legal business name

CORVALLIS NEUROPSYCHOLOGY LLC

Practice address

408 SW Monroe Ave Ste M210D
Corvallis, OR 97333-7228

Phone

(541) 216-4747

Fax

(541) 216-4772

NPI assigned

Mar 29, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Julien Guillaumot, PHD, MSCP, ABPP

Title

Member/Manager

Phone

(541) 908-0223

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565827200000",
    "number": "1174028294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 SW MONROE AVE STE M210D",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973337228",
            "telephone_number": "541-216-4747",
            "fax_number": "541-216-4772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 SW MONROE AVE STE M210D",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973337228",
            "telephone_number": "541-216-4747",
            "fax_number": "541-216-4772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORVALLIS NEUROPSYCHOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-29",
        "last_updated": "2019-08-15",
        "status": "A",
        "authorized_official_last_name": "GUILLAUMOT",
        "authorized_official_first_name": "JULIEN",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "authorized_official_telephone_number": "541-908-0223",
        "authorized_official_credential": "PHD, MSCP, ABPP"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "OR",
            "license": "1683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "278211",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.