| Salal Psychotherapy | |
|
1732 Se Ash St Portland OR 97214-1526 | |
| (503) 222-3125 | |
| Not Available |
| Full Name | Salal Psychotherapy |
|---|---|
| Speciality | Clinic/Center |
| Location | 1732 Se Ash St, Portland, Oregon |
| Authorized Official Name and Position | Ruth Sue Gibian (OWNER) |
| Authorized Official Contact | 5032223125 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Salal Psychotherapy 1732 Se Ash St Portland OR 97214-1526 Ph: (503) 222-3125 | Salal Psychotherapy 1732 Se Ash St Portland OR 97214-1526 Ph: (503) 222-3125 |
| NPI Number | 1205413960 |
|---|---|
| Provider Enumeration Date | 03/26/2021 |
| Last Update Date | 03/26/2021 |
| Certification Date | 03/26/2021 |
| Medicare PECOS PAC ID | 3779981063 |
|---|---|
| Medicare Enrollment ID | O20211018002967 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205413960 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Ruth S Gibian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669531562 PECOS PAC ID: 7416263090 Enrollment ID: I20150827000266 |
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