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General NPI Number Information
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NPI Number | 1487047007
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Entity Type | Organization
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Legal Business Name | PSYCH NW, PC
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 17704 JEAN WAY STE 105
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-5586
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Country | US
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Telephone | 503-877-0711
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Fax | 503-914-0315
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Provider Business Mailing Address
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Address Line | PO BOX 10024
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City | EUGENE
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State | OR
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Zip | 97440-2024
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Country | US
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Telephone | 503-877-0711
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Fax | 503-914-0315
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT T ALVORD
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Credential | PSY, D
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Telephone | 503-476-5005
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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 | 1929
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License Number State | OR
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