Provider Demographics
NPI:1972812634
Name:REBECCA SEIFERT, PSY.D., LLC
Entity Type:Organization
Organization Name:REBECCA SEIFERT, PSY.D., LLC
Other - Org Name:LAKE OSWEGO COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIFERT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-477-0783
Mailing Address - Street 1:3990 COLLINS WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3480
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3990 COLLINS WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3480
Practice Address - Country:US
Practice Address - Phone:503-477-0783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2047103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty