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General NPI Number Information
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NPI Number | 1275260465
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL SERVICES CONNECTION LLC
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Dates
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Enumeration Date | 08/07/2022
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 811 SW 6TH AVE STE 1000
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City | PORTLAND
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State | OR
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Zip | 97204-1345
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Country | US
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Telephone | 503-334-3035
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Fax | 503-961-9212
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Provider Business Mailing Address
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Address Line | 811 SW 6TH AVE STE 1000
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City | PORTLAND
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State | OR
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Zip | 97204-1345
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Country | US
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Telephone | 503-334-3035
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Fax | 503-961-9212
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Authorized Official
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Title or Position | OWNER
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Name | JULIE KEANAAINA
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Credential | MBA, LCSW, LICSW
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Telephone | 503-927-7724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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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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