| Portland Psychological Assessments, Llc | |
|
650 Ne Holladay St Ste 1600 Portland OR 97232-2035 | |
| (971) 770-1813 | |
| (888) 244-7140 |
| Full Name | Portland Psychological Assessments, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 650 Ne Holladay St Ste 1600, Portland, Oregon |
| Authorized Official Name and Position | Jack Wells (OWNER) |
| Authorized Official Contact | 9717701813 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Portland Psychological Assessments, Llc 650 Ne Holladay St Ste 1600 Portland OR 97232-2035 Ph: (971) 770-1813 | Portland Psychological Assessments, Llc 650 Ne Holladay St Ste 1600 Portland OR 97232-2035 Ph: (971) 770-1813 |
| NPI Number | 1104425354 |
|---|---|
| Provider Enumeration Date | 10/20/2020 |
| Last Update Date | 10/20/2020 |
| Certification Date | 10/20/2020 |
| Medicare PECOS PAC ID | 0143631689 |
|---|---|
| Medicare Enrollment ID | O20210222001878 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104425354 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jack Randell Wells |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316246937 PECOS PAC ID: 3274968433 Enrollment ID: I20201130002364 |
| Provider Name | Stephanie M Ravine |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518318542 PECOS PAC ID: 9739475708 Enrollment ID: I20210305000543 |
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