MEDICARE: KALEIDOSCOPE COMMUNITY 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
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1851021646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALEIDOSCOPE COMMUNITY PSYCHOTHERAPY

Provider Business Mailing Address
First Line	:	9320 SW BARBUR BLVD STE 380
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-5430
Country	:	US
Telephone Number	:	971-204-8925
Fax Number	:

Provider Business Practice Location Address
First Line	:	9320 SW BARBUR BLVD STE 380
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-5430
Country	:	US
Telephone Number	:	971-204-8925
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ESTHER SEXTON
Credential	:	PSYD
Telephone Number	:	971-312-9254

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	02/11/2026

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