| Beaverton Psychology Services Llc | |
|
16110 Sw Regatta Ln Beaverton OR 97006-8942 | |
| (503) 526-2917 | |
| Not Available |
| Full Name | Beaverton Psychology Services Llc |
|---|---|
| Speciality | Psychologist |
| Location | 16110 Sw Regatta Ln, Beaverton, Oregon |
| Authorized Official Name and Position | Terri Lynn Mishler (MANAGER) |
| Authorized Official Contact | 5035262917 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beaverton Psychology Services Llc 16110 Sw Regatta Ln Beaverton OR 97006-8942 Ph: (503) 526-2917 | Beaverton Psychology Services Llc 16110 Sw Regatta Ln Beaverton OR 97006-8942 Ph: (503) 526-2917 |
| NPI Number | 1083905996 |
|---|---|
| Provider Enumeration Date | 04/26/2011 |
| Last Update Date | 12/23/2020 |
| Certification Date | 12/23/2020 |
| Medicare PECOS PAC ID | 4587838503 |
|---|---|
| Medicare Enrollment ID | O20111130000784 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083905996 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 811 (Oregon) | Primary |
| Provider Name | Terri L Mishler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639109895 PECOS PAC ID: 0244374734 Enrollment ID: I20100222000722 |
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