Provider Demographics
NPI:1376083261
Name:LICENSED PSYCHOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:LICENSED PSYCHOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDATHA
Authorized Official - Middle Name:TEMPLE
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MA, PHD, LMFT
Authorized Official - Phone:855-583-2842
Mailing Address - Street 1:9123 SE SAINT HELENS ST STE 270B
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6801
Mailing Address - Country:US
Mailing Address - Phone:855-583-2842
Mailing Address - Fax:503-678-9751
Practice Address - Street 1:9123 SE SAINT HELENS ST STE 270B
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6801
Practice Address - Country:US
Practice Address - Phone:855-583-2842
Practice Address - Fax:503-678-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1048106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1184749442OtherNPPES FOR JUDATHA KLINE, PH.D. LMFT