Provider Demographics
NPI:1013293224
Name:JULIE EVANS BINGHAM PHD, LLC
Entity Type:Organization
Organization Name:JULIE EVANS BINGHAM PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-584-9923
Mailing Address - Street 1:528 COTTAGE ST NE
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3811
Mailing Address - Country:US
Mailing Address - Phone:503-584-9923
Mailing Address - Fax:503-584-0303
Practice Address - Street 1:528 COTTAGE ST NE
Practice Address - Street 2:SUITE 1D
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3811
Practice Address - Country:US
Practice Address - Phone:503-584-9923
Practice Address - Fax:503-584-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1523103TC0700X
ORMD198812084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty