Healthcare Provider Details

I. General information

NPI: 1891496972
Provider Name (Legal Business Name): POSITIVE IMPACT PSYCHOLOGY & CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N MAIN AVE
GRESHAM OR
97030-7236
US

IV. Provider business mailing address

502 N MAIN AVE
GRESHAM OR
97030-7236
US

V. Phone/Fax

Practice location:
  • Phone: 503-676-7710
  • Fax:
Mailing address:
  • Phone: 503-676-7710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEC MENDELSON
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 503-676-7710