| NPI | 1376925339 |
|---|---|
| Former Legal Business Name | PORTLAND EVIDENCE BASED PSYCHOTHERAPY CLINIC, INC. |
| Entity Type | Organization |
| Authorized Contact | LOREN WAMPLER Business Operations 503-290-3290 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103T00000X Psychologist | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 104100000X Social Worker | |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2016-12-07 |