Basic Information
| Provider Information | |||||||||
| NPI: | 1437385036 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OREGON HEALTH AND SCIENCE UNIVERSITY | ||||||||
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| OtherOrganizationName: | OHSU INTERCULTURAL PSYCHIATRIC PROGRAM | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3633 SE 35TH PL | ||||||||
| Address2: | ATTN: LIZ STEVENSON | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972023365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034944222 | ||||||||
| FaxNumber: | 5034946143 | ||||||||
| Practice Location | |||||||||
| Address1: | 3633 SE 35TH PL | ||||||||
| Address2: | ATTN: LIZ STEVENSON | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972023365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034944222 | ||||||||
| FaxNumber: | 5034946143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2009 | ||||||||
| LastUpdateDate: | 06/09/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROBERTSON | ||||||||
| AuthorizedOfficialFirstName: | JOE | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5034948252 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.