Portland Pediatric Psychology, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

2482 Issued in OR

Legal business name

PORTLAND PEDIATRIC PSYCHOLOGY, LLC

Practice address

1012 SW King Ave.
Portland, OR 97205-1106

Phone

(503) 673-6246

NPI assigned

Feb 25, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Glori Grubbs Gray, PSYD, MSW

Title

Owner/Therapist

Phone

(503) 673-6246

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1172361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427241600000",
    "number": "1508992652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 SW KING AVE.",
            "address_2": "SUITE 105",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972053035",
            "telephone_number": "503-673-6246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 SW KING AVE.",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051106",
            "telephone_number": "503-673-6246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND PEDIATRIC PSYCHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-25",
        "last_updated": "2015-03-25",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "GLORI",
        "authorized_official_middle_name": "GRUBBS",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "503-673-6246",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, MSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OR",
            "license": "2482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAROLINAS BEHAVIORAL HEAL",
            "identifier": "3598",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "135J9",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6002627",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Portland Orthopedic Services P.C.
• Portland Otologic Clinic PC
• Portland Pain Medicine LLC
• Portland Pediatric Acupuncture
• Portland Pediatric Nutrition
• Portland Peritoneal Center, Inc.
• Portland Physical Therapy
• Portland Plastic Surgery Group, LLC
• Portland Preventive Cardiology LLC
• Portland Pro Health Therapies, PC

• Community/Behavioral Health Agency in Portland, OR
• Providers in Portland, OR by specialty
• Community/Behavioral Health Agency in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; 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.