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General NPI Number Information
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NPI Number | 1053093518
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Entity Type | Organization
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Legal Business Name | SPECIALIZED PSYCHOLOGY SERVICES, LLC
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Dates
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Enumeration Date | 08/03/2023
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 620 SW 5TH AVE STE 900 #151
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City | PORTLAND
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State | OR
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Zip | 97204-1431
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Country | US
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Telephone | 503-298-5208
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Fax |
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Provider Business Mailing Address
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Address Line | 10558 HIGHWAY 62 STE B-1, PMB 1011
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City | EAGLE POINT
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State | OR
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Zip | 97524-9436
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO/DIRECTOR
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Name | DR. JULIE KAHLER
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Credential | PHD
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Telephone | 503-298-5208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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