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MOHANDESSI PSYCH, LLC 833 SW 11th Avenue, Suite 214 Portland, Oregon 97205 Phone: (503) 4819441 Fax: (503) 2245951PATIENT REGISTRATION FORM Demographic Information Name: Home Address: City: State:
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Mohandessi Psych LLC is a limited liability company specialized in providing psychological services.
The owners or members of Mohandessi Psych LLC are required to file the necessary paperwork with the appropriate state authorities.
To fill out Mohandessi Psych LLC, owners or members need to provide information about the business, such as its name, address, management structure, and other relevant details.
The purpose of Mohandessi Psych LLC is to provide psychological services to clients in a professional and ethical manner.
Information such as business name, address, management structure, financial information, and any other required details must be reported on Mohandessi Psych LLC.
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