Provider Demographics
NPI:1700164878
Name:ACT II PSYCHOLOGY, INC.
Entity type:Organization
Organization Name:ACT II PSYCHOLOGY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CORY
Authorized Official - Last Name:BRILLHART
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-400-7500
Mailing Address - Street 1:4742 LIBERTY RD S # 699
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5037
Mailing Address - Country:US
Mailing Address - Phone:503-400-7500
Mailing Address - Fax:503-581-1069
Practice Address - Street 1:1326 KAMELA DR S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-1939
Practice Address - Country:US
Practice Address - Phone:503-400-7500
Practice Address - Fax:503-581-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-23
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR12252868OtherCAQH