NPIMap

Organization Active NPI

360 Pediatric Psychology, PC

  • Clinical Child & Adolescent Psychologist
  • Lake Oswego, OR
National Provider Identifier
1902208846
Registry record updated Sep 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
Legal business name
360 PEDIATRIC PSYCHOLOGY, PC
Practice address
201 B Ave.
Suite #285
Lake Oswego, OR 97034
Phone
(503) 636-0508
Fax
(503) 636-0387
NPI assigned
Sep 23, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2014

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

Authorized official

Name
Dr. Tabitha Sereua Becker, PSY. DNPI 1023411485
Title
Clinical Psychologist Coowner/Partn
Phone
(503) 720-9234

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X Primary

Addresses

Primary practice location

201 B Ave.
Suite #285
Lake Oswego, OR 97034

Mailing address

201 B Ave.
Suite #285
Lake Oswego, OR 97034
Phone (503) 636-0508

National Provider Directory

National Provider Directory

Locations

201 B Ave
Ste 285
Lake Oswego, OR 97034
Phone (503) 636-0508

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1411430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411430400000",
    "number": "1902208846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 B AVE.",
            "address_2": "SUITE #285",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "97034",
            "telephone_number": "503-636-0508",
            "fax_number": "503-636-0387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 B AVE.",
            "address_2": "SUITE #285",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "97034",
            "telephone_number": "503-636-0508",
            "fax_number": "503-636-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "360 PEDIATRIC PSYCHOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-23",
        "last_updated": "2014-09-23",
        "status": "A",
        "authorized_official_last_name": "BECKER",
        "authorized_official_first_name": "TABITHA",
        "authorized_official_middle_name": "SEREUA",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST COOWNER/PARTN",
        "authorized_official_telephone_number": "503-720-9234",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY. D"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; 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.