Organization
GEROMEDICAL PSYCHOLOGICAL SERVICE PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERICK A SCOVEL PHD (PRESIDENT)
(360) 574-9565
Entity
Organization
Contact information
Practice address
3550 SW BOND AVE, PORTLAND, OR 97239-4507
(360) 574-9565
(360) 574-9685
Mailing address
2400 MAIN ST, VANCOUVER, WA 98660-2663
(360) 574-9565
(360) 574-9685
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2074
OR
Other
Enumeration date
04/27/2011
Last updated
09/17/2020
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