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Organization

MARY LEE NICHOLS PHD LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KATHY WINSLOW (OFFICE MANAGER)
(503) 277-3868
Entity
Organization

Contact information

Practice address
1133 NW 21ST AVE, PORTLAND, OR 97209-1513
(503) 277-3868
(503) 650-1892
Mailing address
1133 NW 21ST AVE, PORTLAND, OR 97209-1513
(503) 277-3868
(503) 650-1892

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
949
OR

Other

Enumeration date
09/06/2018
Last updated
09/06/2018
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