Healthcare Provider Details

I. General information

NPI: 1205982709
Provider Name (Legal Business Name): PATRICK ETHEL-KING PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8880 SW NIMBUS AVE STE C
BEAVERTON OR
97008-7111
US

IV. Provider business mailing address

1675 SW MARLOW AVE STE. 301
PORTLAND OR
97225-5104
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-0240
  • Fax: 971-279-5635
Mailing address:
  • Phone: 503-352-0240
  • Fax: 503-352-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1615
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: