ACT II PSYCHOLOGY, INC. (NPI# 1700164878) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700164878 |
| Entity Type | Organization |
| Organization Name | ACT II PSYCHOLOGY, INC. |
| Other Organization Name | N/A |
| Practice Address |
189 Liberty St., Se, Suite 210a The Reed Opera House Salem OR 97301 |
| Practice Telephone | 5034007500 |
| Practice Fax Number | 5035811069 |
| Mailing Telephone | 5034007500 |
| Mailing Fax Number | 5035811069 |
| Enumeration Date | 2011-07-23 |
| Last Update Date | 2012-07-27 |
| Authorized Official Name | DR. DAVID CORY BRILLHART (CLINICAL PSYCHOLOGIST) |
| Authorized Official Telephone | 5034007500 |
| Authorized Official Credential | PSY.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
2162 | OR | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | CAQH | 12252868 | 01 |
| Other Name | Type Code |
|---|---|
| N/A | Former Legal Business Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | ACT II PSYCHOLOGY, INC. | 3723 Fairview Industrial Dr Se, Suite 170, Salem, OR 97302 |
| Street Address |
189 LIBERTY ST., SE, SUITE 210A THE REED OPERA HOUSE |
| City | SALEM |
| State | OR |
| Zip Code | 97301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205450970 | Jehan Seals | Behavior Technician | 3400 State St Set G750, Salem, OR 97301 | 2020-05-29 |
| 1093335929 | Sterling Recovery, LLC | Dietitian, Registered | 3758 Amber St Ne #105, Salem, OR 97301 | 2020-04-21 |
| 1760018360 | Riverfront Mental Health LLC | Counselor | 338 State St, Suite 985, Salem, OR 97301 | 2020-03-16 |
| 1871126888 | Amity Beth Haddon Maxwell | Social Worker | Oregon State Hospital, 2600 Center St Ne, Salem, OR 97301 | 2020-02-18 |
| 1861042632 | Brenda Grizelda Vargas | Behavioral Analyst | 3400 State Ste Ste G750, Salem, OR 97301 | 2019-09-13 |
| 1588213177 | Natalie Stone | Registered Nurse | 2045 Siverton Rd Ne, Salem, OR 97301 | 2019-09-06 |
| 1588228720 | Jeramy Disenso | Counselor | 270 Cottage St Ne, Salem, OR 97301 | 2019-04-23 |
| 1801353297 | Gwendolyn Kersey | Registered Nurse | 2600 Center St Ne Oregon State Hospital, Salem, OR 97301 | 2019-02-21 |
| 1841769114 | Spine Clinic PC | Massage Therapist | 1281 Lancaster Drive Ne, Salem, OR 97301 | 2018-11-16 |
| 1013482132 | Kellie Linn Hansen | Physical Therapist | 4049 Market St Se, Salem, OR 97301 | 2018-10-04 |
| Find all providers in zip 97301 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821696667 | Just for You Counseling | Clinic/Center | 130 Main St Ste 201d, Salem, NH 03079-3173 | 2020-10-14 |
| 1295775799 | Children's Friend and Family Services | Clinic/Center | 110 Boston Street, Salem, MA 01970-4127 | 2006-06-07 |
| 1124625561 | Christian Fauerso | Clinic/Center | 2493 State St, Salem, OR 97301-4543 | 2020-10-08 |
| 1780166116 | Precision Mental Performance LLC | Clinic/Center | 2110 Mission St Se Ste 305, Salem, OR 97302-0038 | 2018-09-01 |
| 1982135265 | Life Tree Pllc | Clinic/Center | 251 W State Road 198 Ste 3, Salem, UT 84653-5608 | 2017-03-27 |
| 1821549544 | Justice Resource Institute, Inc. | Clinic/Center | 110 Boston St, Salem, MA 01970-1402 | 2016-10-18 |
| 1891157723 | Live More Life Everyday Inc | Clinic/Center | 204 Lafayette St, Salem, MA 01970-4721 | 2016-03-21 |
| 1508141185 | Susan Bamford | Clinic/Center | 1845 Commercial St Se, Salem, OR 97302-5203 | 2011-10-14 |
| 1326288754 | North Shore Medical Center Opmh | Clinic/Center | 172 Lafayette St, Salem, MA 01970-4815 | 2009-02-25 |
| 1427269190 | True North PC Therapeutic Options for Mental Health | Clinic/Center | 2695 12th Pl Se, Salem, OR 97302-2537 | 2007-05-24 |
| Find all providers in SALEM | ||||
Please comment or provide details below to improve the information on ACT II PSYCHOLOGY, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.