Healthcare Provider Details

I. General information

NPI: 1952486847
Provider Name (Legal Business Name): STEPHEN DOUGLAS SAEKS PHD, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15455 NW GREENBRIER PKWY SUITE 240
BEAVERTON OR
97006-7374
US

IV. Provider business mailing address

15455 NW GREENBRIER PKWY SUITE 240
BEAVERTON OR
97006-7374
US

V. Phone/Fax

Practice location:
  • Phone: 503-617-0450
  • Fax: 503-617-0475
Mailing address:
  • Phone: 503-617-0450
  • Fax: 503-617-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1425
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00792
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: