Provider Demographics
NPI:1427585546
Name:CORPORATE CONSULTING GROUP, INC
Entity Type:Organization
Organization Name:CORPORATE CONSULTING GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BIRGITTA
Authorized Official - Middle Name:
Authorized Official - Last Name:VON SCHLUMPERGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-226-0828
Mailing Address - Street 1:11905 SW 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7005
Mailing Address - Country:US
Mailing Address - Phone:150-322-6082
Mailing Address - Fax:503-892-8281
Practice Address - Street 1:11905 SW 60TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-7005
Practice Address - Country:US
Practice Address - Phone:503-226-0828
Practice Address - Fax:503-892-8281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR736103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1578554671OtherINDIVIDUAL NPI NUMBER