Organization
PORTLAND PEDIATRIC PSYCHOLOGY, LLC
Active
Organization
PORTLAND PEDIATRIC PSYCHOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLORI GRUBBS GRAY PSYD, MSW (OWNER/THERAPIST)
(503) 673-6246
Entity
Organization
Contact information
Practice address
1012 SW KING AVE., PORTLAND, OR 97205-1106
(503) 673-6246
Mailing address
1012 SW KING AVE., SUITE 105, PORTLAND, OR 97205-3035
(503) 673-6246
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2482
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
135J9
BLUE CROSS BLUE SHIELD
NC
01
—
3598
CAROLINAS BEHAVIORAL HEAL
NC
05
—
6002627
—
NC
Enumeration date
02/25/2007
Last updated
03/25/2015
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