Organization
WESTERN PSYCHOLOGICAL AND COUNSELING SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA ROBERTSON (CONTRACT AND CREDENTIALING)
(503) 233-5405
Entity
Organization
Contact information
Practice address
22070 NE CHINOOK WAY, FAIRVIEW, OR 97024-2647
(971) 275-0294
Mailing address
22070 NE CHINOOK WAY, FAIRVIEW, OR 97024-2647
(971) 275-0294
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
LH 60489053
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000WDBCH-WA
—
WA
Enumeration date
11/26/2015
Last updated
01/26/2018
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