Organization · Type 2 NPI

Radicle Origins, LLC

Clinical Psychologist · Portland, OR

NPI number 1235967530 Active

Practice location

5901 S Macadam Ave Ste 100
Portland, OR 97239-3620

Fax (503) 354-1646

Specialties and licenses

TaxonomyCodeLicense
Clinical Psychologist Primary 103TC0700XNone listed

Clinical Psychologist: A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of discip…

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About NPI 1235967530

Radicle Origins, LLC's National Provider Identifier is 1235967530, issued on Jul 26, 2024. The primary taxonomy on file is Clinical Psychologist (103TC0700X), and the practice location is in Portland, OR. The record was last updated on Oct 30, 2026.