Provider Demographics
NPI:1306560248
Name:MUNDLIN, JENETTE (LPC ASSOC, CRC)
Entity type:Individual
Prefix:
First Name:JENETTE
Middle Name:
Last Name:MUNDLIN
Suffix:
Gender:F
Credentials:LPC ASSOC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 955
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0210
Mailing Address - Country:US
Mailing Address - Phone:971-737-6486
Mailing Address - Fax:
Practice Address - Street 1:915 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7512
Practice Address - Country:US
Practice Address - Phone:971-373-6486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7908101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health