Active NPI
Mary-Lynn Theel, M.D.
- Child & Adolescent Psychiatry Physician
- Beaverton, OR
National Provider Identifier
1497892145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 17319
- Practice address
- 12250 SW 2ND St
Beaverton, OR 97005-2828 - Phone
- (503) 906-7481
- Fax
- (503) 601-0049
- NPI assigned
- Jan 31, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 17319 | OR | Primary |
Addresses
Primary practice location
12250 SW 2ND St
Beaverton, OR 97005-2828
Mailing address
12250 SW 2ND St
Beaverton, OR 97005-2828
Phone (503) 906-7481
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17319 | OR | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392768000000",
"number": "1497892145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12250 SW 2ND ST",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970052828",
"telephone_number": "503-906-7481",
"fax_number": "503-601-0049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12250 SW 2ND ST",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970052828",
"telephone_number": "503-906-7481",
"fax_number": "503-601-0049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEEL",
"first_name": "MARY-LYNN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2014-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "OR",
"license": "17319",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.