Organization
LIFEQUAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIJAY SHANKAR PSY.D. (OWNER)
(503) 531-9355
Entity
Organization
Contact information
Practice address
1975 NW 167TH PL, BEAVERTON, OR 97006-4908
(503) 531-9355
Mailing address
1975 NW 167TH PL, BEAVERTON, OR 97006-4908
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1281
OR
1041C0700X
Clinical Social Worker
2193
OR
171100000X
Acupuncturist
AC169233
OR
Other
Enumeration date
12/09/2015
Last updated
12/09/2015
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