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NPI Code Detail

MEDICARE: WESTERN PSYCHOLOGICAL AND COUNSELING SERVICES PC

MEDICARE: WESTERN PSYCHOLOGICAL AND COUNSELING SERVICES PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor
3103T00000XPsychologist
41041C0700XClinical Social Worker
5101Y00000XCounselor

General Provider Information

NPI Number : 1215468665
Entity Type Code : Organization
Provider Name (Legal Business Name) : WESTERN PSYCHOLOGICAL AND COUNSELING SERVICES PC
Provider Business Mailing Address
First Line : PO BOX 82819
Second Line :
City : PORTLAND
State : OR
Zip : 97282
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2222 E POWELL BLVD
Second Line :
City : GRESHAM
State : OR
Zip : 97080-1365
Country : US
Telephone Number : 503-669-4300
Fax Number : 503-669-4301
Authorized Official
Title or Position : CONTRACT AND CREDENTIALING
Name : AMANDA ROBERTSON
Credential :
Telephone Number : 503-233-5405
Provider Enumeration Date : 03/27/2017
Last Update Date : 01/26/2018

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Directions to “WESTERN PSYCHOLOGICAL AND COUNSELING SERVICES PC ” Practice Location

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