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General NPI Number Information
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NPI Number | 1518203603
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Entity Type | Organization
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Legal Business Name | PACIFIC PSYCHOLOGY GROUP
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Dates
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Enumeration Date | 12/18/2012
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 502 N MAIN AVE
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City | GRESHAM
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State | OR
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Zip | 97030-7236
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Country | US
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Telephone | 503-492-7470
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Fax | 503-492-0939
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Provider Business Mailing Address
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Address Line | 502 N MAIN AVE
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City | GRESHAM
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State | OR
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Zip | 97030-7236
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Country | US
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Telephone | 503-492-7470
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Fax | 503-492-0939
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Authorized Official
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Title or Position | PSY.D.
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Name | GREGORY MORSE
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Credential |
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Telephone | 503-492-7470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 792
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License Number State | OR
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