Organization
SOMATIC CENTER PORTLAND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALISSA D BAZINET PHD (CLINICAL PSYCHOLOGIST)
(619) 203-8403
Entity
Organization
Contact information
Practice address
959 SE DIVISION ST STE 315, PORTLAND, OR 97214-4673
(971) 369-8690
Mailing address
959 SE DIVISION ST STE 315, PORTLAND, OR 97214-4673
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
2084P0800X
Psychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/20/2021
Last updated
05/20/2021
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