Organization · NPI-2

360 Pediatric Psychology, PC

Psychologist, Clinical Child & Adolescent · Lake Oswego, OR

NPI number1902208846

StatusActive

Last updated in NPPESSep 23, 2014

Details

NPI: 1902208846
Entity type: Organization (NPI-2)
Legal business name: 360 Pediatric Psychology, PC
Organization subpart: No
Enumeration date: Sep 23, 2014
Last updated: Sep 23, 2014

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
103TC2200X	Psychologist, Clinical Child & Adolescent	–	–	Yes
103G00000X	Clinical Neuropsychologist	–	–

Practice location

201 B Ave.
Suite #285
Lake Oswego, OR 97034

Phone 503-636-0508 · Fax 503-636-0387

Mailing address

201 B Ave.
Suite #285
Lake Oswego, OR 97034

Phone 503-636-0508 · Fax 503-636-0387

Authorized official

Tabitha Sereua Becker
Clinical Psychologist Coowner/Partn
5037209234

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