| City Of Roses Psychological Services Llc | |
|
1110 Se Alder Street Suite 301 Pmb #4 Portland OR 97214-2400 | |
| (503) 217-4042 | |
| Not Available |
| Full Name | City Of Roses Psychological Services Llc |
|---|---|
| Speciality | Psychologist - Counseling |
| Location | 1110 Se Alder Street, Portland, Oregon |
| Authorized Official Name and Position | Christopher R Raines (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 5037545843 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| City Of Roses Psychological Services Llc 1110 Se Alder Street Suite 301# Pmb4 Portland OR 97214-2400 Ph: (503) 217-4042 | City Of Roses Psychological Services Llc 1110 Se Alder Street Suite 301 Pmb #4 Portland OR 97214-2400 Ph: (503) 217-4042 |
| NPI Number | 1306569793 |
|---|---|
| Provider Enumeration Date | 09/21/2022 |
| Last Update Date | 04/19/2024 |
| Certification Date | 04/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306569793 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
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