Basic Information
| Provider Information | |||||||||
| NPI: | 1013436567 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLORES | ||||||||
| FirstName: | MARCEL | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29998 S WINSLOW RD | ||||||||
| Address2: | |||||||||
| City: | MOLALLA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970389656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038473889 | ||||||||
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| Practice Location | |||||||||
| Address1: | 435 LANCASTER DR NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973014729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035856388 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2017 | ||||||||
| LastUpdateDate: | 12/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PY9989 | FL | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.