Healthcare Provider Details

I. General information

NPI: 1518391580
Provider Name (Legal Business Name): CARLETON H LLOYD PHD, PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 05/20/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 VERMILLION ST
NEWBERG OR
97132-1739
US

IV. Provider business mailing address

915 VERMILLION ST
NEWBERG OR
97132-1739
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-6674
  • Fax:
Mailing address:
  • Phone: 503-538-6674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDC 619
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number508697
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC 9276
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC6430
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSW 16271
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT 580-574
License Number StateTX
# 7
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC6430
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: