Provider Demographics
NPI:1902185234
Name:JMJ PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:JMJ PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:MARTHA
Authorized Official - Last Name:CALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:503-430-8161
Mailing Address - Street 1:16055 SW WALKER RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4942
Mailing Address - Country:US
Mailing Address - Phone:503-430-8161
Mailing Address - Fax:503-640-6182
Practice Address - Street 1:14125 SW FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2567
Practice Address - Country:US
Practice Address - Phone:503-430-8161
Practice Address - Fax:503-640-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1624103TC0700X
OR891103TC0700X
OR2212103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty