Provider Demographics
NPI:1902594054
Name:LANDON MICHAELS PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:LANDON MICHAELS PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:971-258-2328
Mailing Address - Street 1:6708 SE PLUM DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2012
Mailing Address - Country:US
Mailing Address - Phone:719-258-2328
Mailing Address - Fax:
Practice Address - Street 1:6708 SE PLUM DR
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2012
Practice Address - Country:US
Practice Address - Phone:719-258-2328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)