Healthcare Provider Details

I. General information

NPI: 1629051776
Provider Name (Legal Business Name): RORY FLEMING RICHARDSON PH.D., FICPPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4466 NE DEVILS LAKE BLVD SUITE A
LINCOLN CITY OR
97367-5197
US

IV. Provider business mailing address

P.O. BOX 109
LINCOLN CITY OR
97367-0109
US

V. Phone/Fax

Practice location:
  • Phone: 541-994-4462
  • Fax: 541-994-6329
Mailing address:
  • Phone: 541-994-4462
  • Fax: 541-994-6329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC0068
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1249
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1249
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: