Provider Demographics
NPI:1679182364
Name:PSYCHOLOGICAL SERVICES OF PENDLETON, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES OF PENDLETON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:541-278-2222
Mailing Address - Street 1:1100 SOUTHGATE STE 13
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3973
Mailing Address - Country:US
Mailing Address - Phone:541-278-2222
Mailing Address - Fax:541-276-8405
Practice Address - Street 1:1100 SOUTHGATE STE 13
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3973
Practice Address - Country:US
Practice Address - Phone:541-278-2222
Practice Address - Fax:541-276-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty