Healthcare Provider Details

I. General information

NPI: 1427178227
Provider Name (Legal Business Name): HUTTER & SEELEY PSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 MEDFORD CENTER #168
MEDFORD OR
97504
US

IV. Provider business mailing address

711 MEDFORD CENTER #168
MEDFORD OR
97504
US

V. Phone/Fax

Practice location:
  • Phone: 541-601-2968
  • Fax: 541-488-5011
Mailing address:
  • Phone: 541-601-2968
  • Fax: 541-488-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1563
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1573
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1563
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1563
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1573
License Number StateOR

VIII. Authorized Official

Name: DR. ROBIN SEELEY
Title or Position: CORP. SECRETARY
Credential: PH.D.
Phone: 541-601-2968