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General NPI Number Information
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NPI Number | 1770157380
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Entity Type | Organization
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Legal Business Name | MOHANDESSI PSYCH LLC
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 9407 NE VANCOUVER MALL DR # 205
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City | VANCOUVER
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State | WA
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Zip | 98662
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Country | US
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Telephone | 503-481-9441
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Fax | 503-224-5951
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Provider Business Mailing Address
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Address Line | 9407 NE VANCOUVER MALL DR # 205
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City | VANCOUVER
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State | WA
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Zip | 98662
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Country | US
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Telephone | 503-481-9441
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Fax | 503-224-5951
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | SOROUSH MOHANDESSI
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Credential | MD
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Telephone | 503-481-9441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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