Organization
EVERGREEN CLINICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN C GOFF PH.D. (OWNER/DIRECTOR)
(503) 224-0482
Entity
Organization
Contact information
Practice address
5200 SW MACADAM AVE, SUITE 160, PORTLAND, OR 97239-6103
(503) 236-6218
(503) 715-5649
Mailing address
5200 SW MACADAM AVE, SUITE 160, PORTLAND, OR 97239-6103
(503) 236-6218
(503) 715-5649
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1407
OR
Other
Enumeration date
03/28/2011
Last updated
03/28/2011
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