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Organization
LIFETIME OPTIMIZATION, INC.
Active
Organization
LIFETIME OPTIMIZATION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRADLEY ROYCE PENDERGRAFT LCSW (PRESIDENT)
(503) 327-8713
Entity
Organization
Contact information
Practice address
6105 SW MACADAM AVE STE 100, PORTLAND, OR 97239-3640
(503) 327-8713
Mailing address
6105 SW MACADAM AVE STE 100, PORTLAND, OR 97239-3640
(503) 327-8713
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2227
OR
246ZE0500X
EEG Specialist/Technologist
—
NULL
246ZE0500X
EEG Specialist/Technologist
—
—
Other
Enumeration date
03/13/2013
Last updated
03/13/2013
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