Provider Demographics
NPI:1174131759
Name:SHAULIS, GRIFFIN D
Entity type:Individual
Prefix:MR
First Name:GRIFFIN
Middle Name:D
Last Name:SHAULIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20758 SW MARIMAR ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-5486
Mailing Address - Country:US
Mailing Address - Phone:503-960-6013
Mailing Address - Fax:
Practice Address - Street 1:2800 SW PEACEFUL LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-1161
Practice Address - Country:US
Practice Address - Phone:503-516-9085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst