MEDICARE: REBECCA MAHONEY CROSSLEY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	3463	OR

General Provider Information

NPI Number	:	1669126884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA MAHONEY CROSSLEY PHD

Provider Business Mailing Address
First Line	:	2210 SE OAK GROVE BLVD
Second Line	:
City	:	OAK GROVE
State	:	OR
Zip	:	97267-2659
Country	:	US
Telephone Number	:	503-683-2532
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 SE OAK GROVE BLVD
Second Line	:
City	:	OAK GROVE
State	:	OR
Zip	:	97267-2659
Country	:	US
Telephone Number	:	503-683-2532
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	04/24/2026

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