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General NPI Number Information
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NPI Number | 1063917870
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Entity Type | Organization
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Legal Business Name | SALEM PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 325 13TH ST NE STE 502
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City | SALEM
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State | OR
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Zip | 97301-2203
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Country | US
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Telephone | 503-581-2351
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Fax | 503-581-0125
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Provider Business Mailing Address
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Address Line | 325 13TH ST NE STE 502
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City | SALEM
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State | OR
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Zip | 97301-2203
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Country | US
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Telephone | 503-581-2351
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Fax | 503-581-0125
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. JAMES PATRICK MOONEY
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Credential | PH.D.
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Telephone | 503-581-2351
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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 | OR1088
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License Number State | OR
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