Healthcare Provider Details

I. General information

NPI: 1992511430
Provider Name (Legal Business Name): WILLAMETTE VALLEY PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 STATE ST STE 820
SALEM OR
97301-3470
US

IV. Provider business mailing address

5441 S MACADAM AVE STE R
PORTLAND OR
97239-6106
US

V. Phone/Fax

Practice location:
  • Phone: 503-606-6679
  • Fax:
Mailing address:
  • Phone: 503-914-1035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: NATHAN R BAUER
Title or Position: DR.
Credential: PSYD
Phone: 503-277-9640