Provider Demographics
NPI:1851502918
Name:NEUROBEHAVIORAL EVALUATION AND THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:NEUROBEHAVIORAL EVALUATION AND THERAPY SERVICES, LLC
Other - Org Name:NETS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-748-7033
Mailing Address - Street 1:20000 NW WALKER RD
Mailing Address - Street 2:IN CARE OF OGI-OHSU-701
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-8921
Mailing Address - Country:US
Mailing Address - Phone:503-748-7033
Mailing Address - Fax:
Practice Address - Street 1:20000 NW WALKER RD
Practice Address - Street 2:IN CARE OF OGI-OHSU-701
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8921
Practice Address - Country:US
Practice Address - Phone:503-748-7033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1673261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center