Unknown Individual – Clinical Psychologist, NPI 1730202540

Unknown Individual is a healthcare provider. based in West linn, Oregon. specializing in Clinical Psychologist. They hold a License No. PSY18855 (CA). The NPI Number for Unknown Individual is 1730202540

Main info

Organization
Inactive
26 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1730202540
Phone
(310) 502-8784
Address
1573 8TH AVE
Deactivation Date
12 March 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7704619944
Graduation Year
2000 (26 years ago)
PAC ID
7214830728
Group Practice PAC ID
2466340310
Professional Enrollment ID
I20170620003019
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 1573 8TH AVE

    WEST LINN, OR 970684514

    Phone: (310) 502-8784

    Type: Mailing

  • 880 82ND DR

    GLADSTONE, OR 970271803

    Phone: (503) 659-5515

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
90837Psychotherapy, 1 hour8517$0
View full utilization report →

Insurance plans in this area (ZIP 97068)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2466340310View full group profile

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1730202540.
Does inactive mean outdated data for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
How should patients interpret Unknown Individual's specialty?
The extract shows Clinical Psychologist for Unknown Individual. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with West Linn, Oregon in the same public data insurers reference.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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