Healthcare Provider Details

I. General information

NPI: 1245408350
Provider Name (Legal Business Name): ANDREW WILLIAM WHITE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 SW MACADAM AVE SUIDE 580
PORTLAND OR
97239-6103
US

IV. Provider business mailing address

5200 SW MACADAM AVE SUIDE 580
PORTLAND OR
97239-6103
US

V. Phone/Fax

Practice location:
  • Phone: 503-290-3281
  • Fax:
Mailing address:
  • Phone: 503-290-3281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1921
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: