| Opal Institute Llc | |
|
14780 Sw Osprey Dr. #285 Beaverton OR 97007 | |
| (503) 308-4251 | |
| (503) 591-8628 |
| Full Name | Opal Institute Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 14780 Sw Osprey Dr. #285, Beaverton, Oregon |
| Authorized Official Name and Position | Amy Susan Schultz (OWNER) |
| Authorized Official Contact | 5033084251 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Opal Institute Llc 14780 Sw Osprey Dr. #285 Beaverton OR 97007 Ph: (503) 308-4251 | Opal Institute Llc 14780 Sw Osprey Dr. #285 Beaverton OR 97007 Ph: (503) 308-4251 |
| NPI Number | 1639472319 |
|---|---|
| Provider Enumeration Date | 12/17/2010 |
| Last Update Date | 04/17/2013 |
| Medicare PECOS PAC ID | 4587844014 |
|---|---|
| Medicare Enrollment ID | O20110215000914 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639472319 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 1639 (Oregon) | Primary |
| Provider Name | Amy S Friday |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013084300 PECOS PAC ID: 0840254025 Enrollment ID: I20041117000456 |
| Provider Name | C Chyrelle Martin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881921120 PECOS PAC ID: 6608018973 Enrollment ID: I20130815000797 |
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