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General NPI Number Information
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NPI Number | 1851502918
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Entity Type | Organization
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Legal Business Name | NEUROBEHAVIORAL EVALUATION AND THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 20000 NW WALKER RD IN CARE OF OGI-OHSU-701
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City | BEAVERTON
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State | OR
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Zip | 97006-8921
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Country | US
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Telephone | 503-748-7033
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Fax |
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Provider Business Mailing Address
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Address Line | 20000 NW WALKER RD IN CARE OF OGI-OHSU-701
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City | BEAVERTON
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State | OR
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Zip | 97006-8921
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Country | US
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Telephone | 503-748-7033
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. LOIS M BLACK
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Credential | PH.D.
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Telephone | 503-748-7033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1673
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License Number State | OR
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