Provider Demographics
NPI:1275260465
Name:PSYCHOLOGICAL SERVICES CONNECTION LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES CONNECTION LLC
Other - Org Name:PSYCHOLOGICAL SERVICES CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEANAAINA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, LCSW, LICSW
Authorized Official - Phone:503-927-7724
Mailing Address - Street 1:811 SW 6TH AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1345
Mailing Address - Country:US
Mailing Address - Phone:503-334-3035
Mailing Address - Fax:503-961-9212
Practice Address - Street 1:811 SW 6TH AVE STE 1000
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1345
Practice Address - Country:US
Practice Address - Phone:503-334-3035
Practice Address - Fax:503-961-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-07
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)