Individual
DR. MARTHA VILLEGAS-GUTIERREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
12636 SE STARK ST BLDG J, PORTLAND, OR 97233-1058
(503) 253-4609
Mailing address
516 SE MORRISON ST STE 221, PORTLAND, OR 97214-2342
(503) 702-7558
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2027
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000WDBCH
MEDICARE
OR
05
—
164936
—
OR
Enumeration date
02/23/2015
Last updated
03/29/2018
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