Individual
LELAND ST. CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
2700 SE 26TH AVE STE C, PORTLAND, OR 97202-1288
(503) 755-8808
Mailing address
8415 SE 75TH AVE, PORTLAND, OR 97206-8613
(503) 755-8808
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5872
MN
Other
Enumeration date
04/11/2016
Last updated
03/06/2022
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