| Mary Lee Nichols Phd Llc | |
|
1133 Nw 21st Ave Portland OR 97209-1513 | |
| (503) 277-3868 | |
| (503) 650-1892 |
| Full Name | Mary Lee Nichols Phd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1133 Nw 21st Ave, Portland, Oregon |
| Authorized Official Name and Position | Kathy Winslow (OFFICE MANAGER) |
| Authorized Official Contact | 5032773868 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Lee Nichols Phd Llc 1133 Nw 21st Ave Portland OR 97209-1513 Ph: (503) 277-3868 | Mary Lee Nichols Phd Llc 1133 Nw 21st Ave Portland OR 97209-1513 Ph: (503) 277-3868 |
| NPI Number | 1861974776 |
|---|---|
| Provider Enumeration Date | 09/06/2018 |
| Last Update Date | 09/06/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861974776 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 949 (Oregon) | Primary |
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