Basic Information
| Provider Information | |||||||||
| NPI: | 1457721979 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWALLEN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 SE 8TH AVE # 181 | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971234216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033527333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21900 WILLAMETTE DR STE 202 | ||||||||
| Address2: | |||||||||
| City: | WEST LINN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970683284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036530631 | ||||||||
| FaxNumber: | 5036531464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2015 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.