Provider Demographics
NPI:1750856084
Name:DAVID ROBERT GLEAVE, PSYD, LLC
Entity Type:Organization
Organization Name:DAVID ROBERT GLEAVE, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GLEAVE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:971-350-8776
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-0223
Mailing Address - Country:US
Mailing Address - Phone:971-350-8776
Mailing Address - Fax:
Practice Address - Street 1:1800 BLANKENSHIP RD STE 200
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4174
Practice Address - Country:US
Practice Address - Phone:971-350-8776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-13
Last Update Date:2018-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)