Individual
MARTIN TERRANCE LALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD PSYCHOLOGIST
Contact information
Practice address
1121 NE 2ND, OREGON STATE HOSPITAL, PORTLAND, OR 97232
(503) 731-8656
Mailing address
PO BOX 14900, STATE OF OREGON IRS UNIT, SALEM, OR 97309-5016
(503) 945-9840
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
712
OR
Other
Enumeration date
09/28/2006
Last updated
07/08/2007
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