| Geromedical Psychological Service Ps | |
|
3550 Sw Bond Ave Portland OR 97239-4507 | |
| (360) 574-9565 | |
| (360) 574-9685 |
| Full Name | Geromedical Psychological Service Ps |
|---|---|
| Speciality | Psychologist |
| Location | 3550 Sw Bond Ave, Portland, Oregon |
| Authorized Official Name and Position | Derick A Scovel (PRESIDENT) |
| Authorized Official Contact | 3605749565 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Geromedical Psychological Service Ps 2400 Main St Vancouver WA 98660-2663 Ph: (360) 574-9565 | Geromedical Psychological Service Ps 3550 Sw Bond Ave Portland OR 97239-4507 Ph: (360) 574-9565 |
| NPI Number | 1043501836 |
|---|---|
| Provider Enumeration Date | 04/27/2011 |
| Last Update Date | 09/17/2020 |
| Certification Date | 09/17/2020 |
| Medicare PECOS PAC ID | 9436180684 |
|---|---|
| Medicare Enrollment ID | O20110623000712 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043501836 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2074 (Oregon) | Primary |
| Provider Name | Derick C Scovel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407967813 PECOS PAC ID: 2264428820 Enrollment ID: I20110706000170 |
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