Provider Demographics
NPI:1982105862
Name:MITCHELL VON BUTTLAR, ASHLEE BETH (PHD)
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:BETH
Last Name:MITCHELL VON BUTTLAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ASHLEE
Other - Middle Name:BETH
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:
Practice Address - Street 1:9155 SW BARNES RD STE 634
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6632
Practice Address - Country:US
Practice Address - Phone:971-345-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3339103G00000X, 103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist