| Leland St. Charles, Psychologist, Llc | |
|
1210 Se Oak St Portland OR 97214-1427 | |
| (503) 755-8808 | |
| (971) 339-8595 |
| Full Name | Leland St. Charles, Psychologist, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1210 Se Oak St, Portland, Oregon |
| Authorized Official Name and Position | Leland St Charles (PSYCHOLOGIST, OWNER, SOLE MEMBER) |
| Authorized Official Contact | 5037558808 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Leland St. Charles, Psychologist, Llc 8415 Se 75th Ave Portland OR 97206-8613 Ph: (415) 710-6141 | Leland St. Charles, Psychologist, Llc 1210 Se Oak St Portland OR 97214-1427 Ph: (503) 755-8808 |
| NPI Number | 1427708171 |
|---|---|
| Provider Enumeration Date | 03/25/2022 |
| Last Update Date | 01/07/2023 |
| Certification Date | 01/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427708171 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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