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Organization
PORTLAND NEUROFEEDBACK, LLC
Active
Organization
PORTLAND NEUROFEEDBACK, LLC
Active
Other names
The PATH Center
Organization subpart
No
Provider details
NPI number
Authorized official
GAIL WOUNG (CREDENTIALING COORDINATOR)
(971) 940-2601
Entity
Organization
Contact information
Practice address
4035 NE SANDY BLVD # 200, PORTLAND, OR 97212-5331
(971) 940-2601
(971) 275-1534
Mailing address
4035 NE SANDY BLVD STE 240, PORTLAND, OR 97212-5331
(971) 940-2601
(971) 275-1534
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5006392224
—
OR
05
—
500738886
—
OR
Enumeration date
11/30/2017
Last updated
11/01/2022
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