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General NPI Number Information
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NPI Number | 1104456672
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Entity Type | Organization
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Legal Business Name | SKYHOOK COUNSELING CENTER LLC
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 12008 SW GARDEN PL
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City | TIGARD
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State | OR
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Zip | 97223-8263
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Country | US
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Telephone | 503-352-9863
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Fax |
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Provider Business Mailing Address
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Address Line | 10640 SE CHARLOTTE DR
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-2161
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Country | US
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Telephone | 503-740-7588
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | DR. TERRY JENKINS
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Credential | PSY.D.
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Telephone | 503-740-7589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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