Provider Demographics
NPI:1477862142
Name:PSYCHMED LLC
Entity Type:Organization
Organization Name:PSYCHMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARRELLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-516-9308
Mailing Address - Street 1:PO BOX 12745
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-0745
Mailing Address - Country:US
Mailing Address - Phone:503-516-9308
Mailing Address - Fax:
Practice Address - Street 1:2354 SE 59TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-4018
Practice Address - Country:US
Practice Address - Phone:503-516-9308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1626103TC0700X
163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty