Provider Demographics
NPI:1801067491
Name:APPLEGATE PSYCHOLOGY & ASSOC, LLC
Entity type:Organization
Organization Name:APPLEGATE PSYCHOLOGY & ASSOC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-459-0907
Mailing Address - Street 1:1739 GARNET AVE
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-9677
Mailing Address - Country:US
Mailing Address - Phone:541-459-0907
Mailing Address - Fax:541-459-0907
Practice Address - Street 1:1739 GARNET AVE
Practice Address - Street 2:
Practice Address - City:SUTHERLIN
Practice Address - State:OR
Practice Address - Zip Code:97479-9677
Practice Address - Country:US
Practice Address - Phone:541-459-0907
Practice Address - Fax:541-459-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1309103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181430Medicaid
OR115238Medicare PIN