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General NPI Number Information
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NPI Number | 1902185234
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Entity Type | Organization
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Legal Business Name | JMJ PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 08/04/2011
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Last Update Date | 08/04/2011
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Provider Practice Location Address
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Address Line | 14125 SW FARMINGTON RD
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City | BEAVERTON
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State | OR
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Zip | 97005-2567
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Country | US
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Telephone | 503-430-8161
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Fax | 503-640-6182
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Provider Business Mailing Address
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Address Line | 16055 SW WALKER RD SUITE 114
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City | BEAVERTON
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State | OR
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Zip | 97006-4942
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Country | US
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Telephone | 503-430-8161
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Fax | 503-640-6182
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. LUZ MARTHA CALLUM
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Credential | ED.D.
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Telephone | 503-430-8161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1624
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 2212
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 891
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License Number State | OR
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