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General NPI Number Information
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NPI Number | 1659164390
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Entity Type | Organization
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Legal Business Name | PACIFIC THERAPY LLC
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Dates
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Enumeration Date | 05/26/2025
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Last Update Date | 05/26/2025
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Provider Practice Location Address
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Address Line | 917 SW OAK ST STE 417
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City | PORTLAND
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State | OR
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Zip | 97205-2807
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Country | US
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Telephone | 503-278-5908
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Fax | 503-961-7985
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Provider Business Mailing Address
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Address Line | 3055 NW YEON AVE UNIT 274
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City | PORTLAND
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State | OR
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Zip | 97210-1519
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | HILLEL SAMLAN
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Credential | PHD
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Telephone | 503-278-5908
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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 |
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License Number State |
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