Portland Psychological Assessments, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

PORTLAND PSYCHOLOGICAL ASSESSMENTS, LLC

Practice address

650 NE Holladay St Ste 1600
Portland, OR 97232-2035

Phone

(971) 770-1813

Fax

(888) 244-7140

NPI assigned

Oct 20, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jack Wells, PSYD

Title

Owner

Phone

(971) 770-1813

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1104425354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 NE HOLLADAY ST STE 1600",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322035",
            "telephone_number": "971-770-1813",
            "fax_number": "888-244-7140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 NE HOLLADAY ST STE 1600",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322035",
            "telephone_number": "971-770-1813",
            "fax_number": "888-244-7140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND PSYCHOLOGICAL ASSESSMENTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-20",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "971-770-1813",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.