| Sport Psychology Institute Northwest | |
|
833 Sw 11th Ave Suite 925 Portland OR 97205-2125 | |
| (866) 300-1515 | |
| Not Available |
| Full Name | Sport Psychology Institute Northwest |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 833 Sw 11th Ave, Portland, Oregon |
| Authorized Official Name and Position | Mark Henry (PRESIDENT) |
| Authorized Official Contact | 8663001515 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sport Psychology Institute Northwest 833 Sw 11th Ave Suite 925 Portland OR 97205-2125 Ph: (866) 300-1515 | Sport Psychology Institute Northwest 833 Sw 11th Ave Suite 925 Portland OR 97205-2125 Ph: (866) 300-1515 |
| NPI Number | 1457667206 |
|---|---|
| Provider Enumeration Date | 08/30/2010 |
| Last Update Date | 08/30/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457667206 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | C1433 (Oregon) | Primary |
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