| Intercultural Center For Psychology Llc | |
|
710c Foothills Dr Suite 104 Newberg OR 97132 | |
| (503) 930-2065 | |
| Not Available |
| Full Name | Intercultural Center For Psychology Llc |
|---|---|
| Speciality | Psychologist |
| Location | 710c Foothills Dr, Newberg, Oregon |
| Authorized Official Name and Position | Sergiy Barsukov (PSYCHOLOGIST) |
| Authorized Official Contact | 5039302065 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intercultural Center For Psychology Llc Po Box 256 Newberg OR 97132-0256 Ph: (503) 930-2065 | Intercultural Center For Psychology Llc 710c Foothills Dr Suite 104 Newberg OR 97132 Ph: (503) 930-2065 |
| NPI Number | 1487931523 |
|---|---|
| Provider Enumeration Date | 11/03/2011 |
| Last Update Date | 10/21/2020 |
| Certification Date | 10/21/2020 |
| Medicare PECOS PAC ID | 2062831415 |
|---|---|
| Medicare Enrollment ID | O20201004000019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487931523 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 1935 (Oregon) | Primary |
| Provider Name | Sergiy V Barsukov |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356538847 PECOS PAC ID: 7315074416 Enrollment ID: I20100421000807 |
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