Provider Demographics
NPI:1205139854
Name:PSYCHOLOGICAL HEALTH SERVICES, P.C.
Entity type:Organization
Organization Name:PSYCHOLOGICAL HEALTH SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:971-678-3941
Mailing Address - Street 1:PO BOX 92004
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-2004
Mailing Address - Country:US
Mailing Address - Phone:971-678-3941
Mailing Address - Fax:503-252-2720
Practice Address - Street 1:10000 SE MAIN ST STE 148
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2462
Practice Address - Country:US
Practice Address - Phone:971-678-3941
Practice Address - Fax:503-252-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR612103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty