| Psych Nw, Pc | |
|
17704 Jean Way Ste 105 Lake Oswego OR 97035-5586 | |
| (503) 877-0711 | |
| (503) 914-0315 |
| Full Name | Psych Nw, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 17704 Jean Way Ste 105, Lake Oswego, Oregon |
| Authorized Official Name and Position | Scott T Alvord (PRESIDENT) |
| Authorized Official Contact | 5034765005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psych Nw, Pc Po Box 10024 Eugene OR 97440-2024 Ph: (503) 877-0711 | Psych Nw, Pc 17704 Jean Way Ste 105 Lake Oswego OR 97035-5586 Ph: (503) 877-0711 |
| NPI Number | 1487047007 |
|---|---|
| Provider Enumeration Date | 03/05/2015 |
| Last Update Date | 03/05/2015 |
| Medicare PECOS PAC ID | 3375878952 |
|---|---|
| Medicare Enrollment ID | O20190718002761 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487047007 | NPI | - | NPPES |
| 500614581MCD | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 1929 (Oregon) | Primary |
| Provider Name | Scott Thomas Alvord |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013245455 PECOS PAC ID: 6002141686 Enrollment ID: I20190718002913 |
| Provider Name | Stephen Hans Stoltzfus |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942866470 PECOS PAC ID: 7315394012 Enrollment ID: I20231116001837 |
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