| Southern Oregon Psychological Services Llc | |
|
305 Ne E St Ste 200b Grants Pass OR 97526-2163 | |
| (541) 226-4396 | |
| Not Available |
| Full Name | Southern Oregon Psychological Services Llc |
|---|---|
| Speciality | Psychologist |
| Location | 305 Ne E St Ste 200b, Grants Pass, Oregon |
| Authorized Official Name and Position | Matthew Ditty (OWNER) |
| Authorized Official Contact | 5412264396 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Oregon Psychological Services Llc 305 Ne E St Ste 200b Grants Pass OR 97526-2163 Ph: () - | Southern Oregon Psychological Services Llc 305 Ne E St Ste 200b Grants Pass OR 97526-2163 Ph: (541) 226-4396 |
| NPI Number | 1245946110 |
|---|---|
| Provider Enumeration Date | 01/25/2023 |
| Last Update Date | 05/23/2024 |
| Certification Date | 05/23/2024 |
| Medicare PECOS PAC ID | 6406220615 |
|---|---|
| Medicare Enrollment ID | O20230329001485 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245946110 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Matthew Jacob Ditty |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760750319 PECOS PAC ID: 7214301423 Enrollment ID: I20230329001543 |
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