Provider Demographics
NPI:1750753687
Name:UNIVERSITY PROFESSIONAL SERVICES
Entity type:Organization
Organization Name:UNIVERSITY PROFESSIONAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. ASSOC. DEAN FOR CLINICAL PRACT.
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:HECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-494-4481
Mailing Address - Street 1:2214 LLOYD CENTER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1315
Mailing Address - Country:US
Mailing Address - Phone:503-494-4222
Mailing Address - Fax:503-494-6143
Practice Address - Street 1:2214 LLOYD CENTER
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1315
Practice Address - Country:US
Practice Address - Phone:503-494-4222
Practice Address - Fax:503-494-6143
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY PROFESSIONAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-30
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health