Healthcare Provider Details

I. General information

NPI: 1013293224
Provider Name (Legal Business Name): JULIE EVANS BINGHAM PHD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 COTTAGE ST NE SUITE 1D
SALEM OR
97301-3811
US

IV. Provider business mailing address

528 COTTAGE ST NE SUITE 1D
SALEM OR
97301-3811
US

V. Phone/Fax

Practice location:
  • Phone: 503-584-9923
  • Fax: 503-584-0303
Mailing address:
  • Phone: 503-584-9923
  • Fax: 503-584-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1523
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD19881
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD19881
License Number StateOR

VIII. Authorized Official

Name: DR. JULIE EVANS BINGHAM
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 503-584-9923