| Portland Neurofeedback, Llc | |
|
4035 Ne Sandy Blvd # 200 Portland OR 97212-5331 | |
| (971) 940-2601 | |
| (971) 275-1534 |
| Full Name | Portland Neurofeedback, Llc |
|---|---|
| Speciality | Counselor |
| Location | 4035 Ne Sandy Blvd # 200, Portland, Oregon |
| Authorized Official Name and Position | Gail Woung (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 9719402601 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Portland Neurofeedback, Llc 4035 Ne Sandy Blvd Ste 240 Portland OR 97212-5331 Ph: (971) 940-2601 | Portland Neurofeedback, Llc 4035 Ne Sandy Blvd # 200 Portland OR 97212-5331 Ph: (971) 940-2601 |
| NPI Number | 1558875476 |
|---|---|
| Provider Enumeration Date | 11/30/2017 |
| Last Update Date | 11/01/2022 |
| Certification Date | 11/01/2022 |
| Medicare PECOS PAC ID | 6002155058 |
|---|---|
| Medicare Enrollment ID | O20190308001406 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558875476 | NPI | - | NPPES |
| 500738886 | Medicaid | OR | |
| 5006392224 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (Oregon) | Primary |
| Provider Name | Gail Margaret Hardman-woung |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861571317 PECOS PAC ID: 9537301981 Enrollment ID: I20190308001516 |
| Provider Name | Pauline Ann Robert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326557927 PECOS PAC ID: 5799187274 Enrollment ID: I20210706003038 |
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