| Portland Pediatric Psychology, Llc | |
|
1012 Sw King Ave. Portland OR 97205-1106 | |
| (503) 673-6246 | |
| Not Available |
| Full Name | Portland Pediatric Psychology, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1012 Sw King Ave., Portland, Oregon |
| Authorized Official Name and Position | Glori Grubbs Gray (OWNER/THERAPIST) |
| Authorized Official Contact | 5036736246 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Portland Pediatric Psychology, Llc 1012 Sw King Ave. Suite 105 Portland OR 97205-3035 Ph: (503) 673-6246 | Portland Pediatric Psychology, Llc 1012 Sw King Ave. Portland OR 97205-1106 Ph: (503) 673-6246 |
| NPI Number | 1508992652 |
|---|---|
| Provider Enumeration Date | 02/25/2007 |
| Last Update Date | 03/25/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508992652 | NPI | - | NPPES |
| 3598 | Other | NC | CAROLINAS BEHAVIORAL HEAL |
| 135J9 | Other | NC | BLUE CROSS BLUE SHIELD |
| 6002627 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2482 (Oregon) | Primary |
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