Providence Health & Services - Oregon
Psychologist, Cognitive & Behavioral in Portland, OR. Organization (NPI-2).
Details
- NPI
- 1679697247
- Entity type
- Organization (NPI-2)
- Legal business name
- Providence Health & Services - Oregon
- Organization subpart
- No
- Enumeration date
- Mar 19, 2007
- Certification date
- Jul 4, 2025
- Last updated
- Jul 4, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TB0200X | Psychologist, Cognitive & Behavioral | – | – | Yes |
| 261Q00000X | Clinic/Center | – | – |
Other names
- Providence Medical Group (Doing Business As)
- Providence Cognitive Assessment Clinic (Doing Business As)
Practice location
9155 Sw Barnes RdSuite 317
Portland, OR 97225-6630
Phone 503-216-1150
Mailing address
Po Box 31001 - 4180Pasadena, CA 91110-4180
Authorized official
Donald Wayne Anderson
Assistant Secreatry For Enrollment
4253589786
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Cognitive & Behavioral Psychologist providers in Portland, OR
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- Kevin Barry McGovern, PH.D.NPI 1043439532
All 22 Cognitive & Behavioral Psychologist providers in Portland · All 48,847 providers in Portland
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