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9120 Ne Vancouver Mall Loop Ste 262 Vancouver WA 98662-6391 | |
| (541) 702-7400 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 9120 Ne Vancouver Mall Loop Ste 262, Vancouver, Washington |
| Authorized Official Name and Position | David Opollo Ross (CLINICAL DIRECTOR) |
| Authorized Official Contact | 3606022620 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6715 Ne 63rd St Ste 277 Vancouver WA 98661-1980 Ph: (360) 602-2620 | 9120 Ne Vancouver Mall Loop Ste 262 Vancouver WA 98662-6391 Ph: (541) 702-7400 |
| NPI Number | 1124883160 |
|---|---|
| Provider Enumeration Date | 02/19/2024 |
| Last Update Date | 07/11/2024 |
| Certification Date | 07/11/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124883160 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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