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NPI Code Detail

MEDICARE: WM PSYCHOTHERAPY

MEDICARE: WM PSYCHOTHERAPY
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
1103TC1900XCounseling Psychologist

General Provider Information

NPI Number : 1689454282
Entity Type Code : Organization
Provider Name (Legal Business Name) : WM PSYCHOTHERAPY
Provider Business Mailing Address
First Line : 7928 SE 21ST AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97202-6803
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3407 S CORBETT AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4621
Country : US
Telephone Number : 206-428-7855
Fax Number :
Authorized Official
Title or Position : PSYCHOLOGIST
Name : WEI MOTULSKY
Credential : PHD
Telephone Number : 206-428-7855
Provider Enumeration Date : 10/02/2023
Last Update Date : 01/04/2024

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Directions to “WM PSYCHOTHERAPY ” Practice Location

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