Healthcare Provider Details

I. General information

NPI: 1679182364
Provider Name (Legal Business Name): PSYCHOLOGICAL SERVICES OF PENDLETON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SOUTHGATE STE 13
PENDLETON OR
97801-3973
US

IV. Provider business mailing address

1100 SOUTHGATE STE 13
PENDLETON OR
97801-3973
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-2222
  • Fax: 541-276-8405
Mailing address:
  • Phone: 541-278-2222
  • Fax: 541-276-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NATALIE KOLLROSS
Title or Position: OWNER
Credential: PSY D
Phone: 541-278-2222