| NPI | 1124465182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDA B BAX Secretary/Treasurer 503-222-0707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 1568) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OR 1568) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2022-09-01 |