Healthcare Provider Details

I. General information

NPI: 1083521892
Provider Name (Legal Business Name): CBT PORTLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SE SPOKANE ST STE 300
PORTLAND OR
97202-6487
US

IV. Provider business mailing address

205 SE SPOKANE ST STE 300
PORTLAND OR
97202-6487
US

V. Phone/Fax

Practice location:
  • Phone: 503-395-2143
  • Fax:
Mailing address:
  • Phone: 503-395-2143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. HAYLEY DAUTERMAN
Title or Position: OWNER
Credential: PHD
Phone: 503-395-2143