Organization
PACIFIC PREMIER GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN HEPNER-HALL (DIRECTOR OF OPERATIONS)
(971) 801-6448
Entity
Organization
Contact information
Practice address
4730 S MACADAM AVE STE 201, PORTLAND, OR 97239-6417
(503) 278-5665
(503) 241-2367
Mailing address
4730 S MACADAM AVE STE 201, PORTLAND, OR 97239-6417
(503) 278-5665
(503) 241-2367
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
12/16/2021
Last updated
12/16/2021
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