Healthcare Provider Details

I. General information

NPI: 1972412575
Provider Name (Legal Business Name): OLLA PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 SW BARBUR BLVD STE 110
PORTLAND OR
97219-5425
US

IV. Provider business mailing address

9500 SW BARBUR BLVD STE 110
PORTLAND OR
97219-5425
US

V. Phone/Fax

Practice location:
  • Phone: 970-779-9026
  • Fax:
Mailing address:
  • Phone: 970-779-9026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: CARL SALLEE
Title or Position: OWNER
Credential: PSYD, LP
Phone: 970-779-9026