Healthcare Provider Details

I. General information

NPI: 1700153699
Provider Name (Legal Business Name): CHRISTINE GRACE OVIATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E MAIN ST SUITE 110
HILLSBORO OR
97123-4191
US

IV. Provider business mailing address

2323 NW 188TH AVE APT. 824
HILLSBORO OR
97124-7039
US

V. Phone/Fax

Practice location:
  • Phone: 503-640-9892
  • Fax: 503-648-9732
Mailing address:
  • Phone: 503-640-9892
  • Fax: 503-648-9732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: