| Pacific Northwest Psychological Services | |
|
1623 Se Lexington St Portland OR 97202-6106 | |
| (503) 756-3982 | |
| Not Available |
| Full Name | Pacific Northwest Psychological Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 1623 Se Lexington St, Portland, Oregon |
| Authorized Official Name and Position | Stephen James Boyd (OWNER) |
| Authorized Official Contact | 5037563982 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific Northwest Psychological Services 1623 Se Lexington St Portland OR 97202-6106 Ph: () - | Pacific Northwest Psychological Services 1623 Se Lexington St Portland OR 97202-6106 Ph: (503) 756-3982 |
| NPI Number | 1932838786 |
|---|---|
| Provider Enumeration Date | 06/07/2022 |
| Last Update Date | 06/07/2022 |
| Certification Date | 06/07/2022 |
| Medicare PECOS PAC ID | 1658753652 |
|---|---|
| Medicare Enrollment ID | O20220808003219 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932838786 | NPI | - | NPPES |
| 1295240190 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Stephen James Boyd |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033646484 PECOS PAC ID: 6800156803 Enrollment ID: I20180213001940 |
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