NPI 1902208846 · live from the CMS NPI Registry
360 Pediatric Psychology, PC
Psychologist, Clinical Child & Adolescent in Lake Oswego, OR. National Provider Identifier 1902208846, active.
NPI record
| NPI | 1902208846 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Psychologist, Clinical Child & Adolescent 103TC2200X |
| Practice location | 201 B Ave., Suite #285, Lake Oswego, OR 97034 |
| Practice phone | 503-636-0508 |
| Enumerated | September 23, 2014 |
| Last updated | September 23, 2014 |
| Authorized official | Tabitha Becker, Clinical Psychologist Coowner/Partn |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Clinical Neuropsychologist | 103G00000X | — |
| Psychologist, Clinical Child & Adolescent primary | 103TC2200X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.