Healthcare Provider Details

I. General information

NPI: 1679861637
Provider Name (Legal Business Name): BOBBY L TRIHUB PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 ESTHER ST
NEWBERG OR
97132-9529
US

IV. Provider business mailing address

1901 ESTHER ST
NEWBERG OR
97132-9529
US

V. Phone/Fax

Practice location:
  • Phone: 503-554-4359
  • Fax:
Mailing address:
  • Phone: 503-554-4359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2141
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: