Provider Demographics
NPI:1023759867
Name:CYTI PSYCHOLOGY OREGON PC
Entity type:Organization
Organization Name:CYTI PSYCHOLOGY OREGON PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUN JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-772-3277
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-0220
Mailing Address - Country:US
Mailing Address - Phone:808-772-3277
Mailing Address - Fax:
Practice Address - Street 1:19960 SW 112TH AVE
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7626
Practice Address - Country:US
Practice Address - Phone:971-219-1552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)