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General NPI Number Information
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NPI Number | 1023408341
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL SERVICES CENTER, P.C.
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Dates
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Enumeration Date | 01/24/2015
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Last Update Date | 01/24/2015
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Provider Practice Location Address
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Address Line | 1800 BLANKENSHIP RD STE 200
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City | WEST LINN
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State | OR
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Zip | 97068-4174
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Country | US
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Telephone | 971-400-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 BLANKENSHIP RD STE 200
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City | WEST LINN
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State | OR
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Zip | 97068-4174
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Country | US
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Telephone | 971-400-5544
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERRENCE WAGER
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Credential | PSY.D.
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Telephone | 971-400-5544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 2220
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License Number State | OR
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