1255738092 NPI number — WESTERN PSYCHOLOGICAL AND COUNSELING SERVICES PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255738092 NPI number — WESTERN PSYCHOLOGICAL AND COUNSELING SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN PSYCHOLOGICAL AND COUNSELING SERVICES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255738092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 82819
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-233-5405
Provider Business Mailing Address Fax Number:
503-233-2694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
870 SE 82ND
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLADSTONE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-656-5515
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTSON
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACT AND CREDENTIALING
Authorized Official Telephone Number:
503-233-5405

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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