Provider Demographics
NPI:1023408341
Name:PSYCHOLOGICAL SERVICES CENTER, P.C.
Entity type:Organization
Organization Name:PSYCHOLOGICAL SERVICES CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:971-400-5544
Mailing Address - Street 1:1800 BLANKENSHIP RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4174
Mailing Address - Country:US
Mailing Address - Phone:971-400-5544
Mailing Address - Fax:
Practice Address - Street 1:1800 BLANKENSHIP RD STE 200
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4174
Practice Address - Country:US
Practice Address - Phone:971-400-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2220103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty