Basic Information
| Provider Information | |||||||||
| NPI: | 1073056826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN PSYCHOLOGICAL AND COUNSELING SERVICES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 82819 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972820819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032335405 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18765 SW BOONES FERRY RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | TUALATIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970628607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036121000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2016 | ||||||||
| LastUpdateDate: | 06/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | BRASI | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9717190084 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |
No ID Information.