Provider Demographics
NPI:1891496972
Name:POSITIVE IMPACT PSYCHOLOGY & CONSULTING
Entity Type:Organization
Organization Name:POSITIVE IMPACT PSYCHOLOGY & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEC
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-676-7710
Mailing Address - Street 1:502 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7236
Mailing Address - Country:US
Mailing Address - Phone:503-676-7710
Mailing Address - Fax:
Practice Address - Street 1:502 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7236
Practice Address - Country:US
Practice Address - Phone:503-676-7710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health