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22344 Sw Main St Sherwood OR 97140-9416 | |
| (503) 625-2768 | |
| (503) 625-3768 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Cognitive & Behavioral |
| Location | 22344 Sw Main St, Sherwood, Oregon |
| Authorized Official Name and Position | Gene Random Head (PRESIDENT) |
| Authorized Official Contact | 5036252768 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
22344 Sw Main St Sherwood OR 97140-9416 Ph: (503) 625-2768 | 22344 Sw Main St Sherwood OR 97140-9416 Ph: (503) 625-2768 |
| NPI Number | 1457526964 |
|---|---|
| Provider Enumeration Date | 04/25/2008 |
| Last Update Date | 04/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457526964 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | (* (Not Available)) | Primary |
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