| Act Ii Psychology, Inc. | |
|
189 Liberty St., Se, Suite 210a The Reed Opera House Salem OR 97301 | |
| (503) 400-7500 | |
| (503) 581-1069 |
| Full Name | Act Ii Psychology, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 189 Liberty St., Se, Suite 210a, Salem, Oregon |
| Authorized Official Name and Position | David Cory Brillhart (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 5034007500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Act Ii Psychology, Inc. 189 Liberty St., Se, Suite 210a The Reed Opera House Salem OR 97301 Ph: (503) 400-7500 | Act Ii Psychology, Inc. 189 Liberty St., Se, Suite 210a The Reed Opera House Salem OR 97301 Ph: (503) 400-7500 |
| NPI Number | 1700164878 |
|---|---|
| Provider Enumeration Date | 07/23/2011 |
| Last Update Date | 07/27/2012 |
| Medicare PECOS PAC ID | 3476723750 |
|---|---|
| Medicare Enrollment ID | O20110824000003 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700164878 | NPI | - | NPPES |
| 12252868 | Other | OR | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 2162 (Oregon) | Primary |
| Provider Name | David C Brillhart |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700170818 PECOS PAC ID: 4385814664 Enrollment ID: I20110824000004 |
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