Healthcare Provider Details

I. General information

NPI: 1033906532
Provider Name (Legal Business Name): OWEN HUGH CRABTREE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4284 N MARYLAND AVE APT 415
PORTLAND OR
97217-3273
US

IV. Provider business mailing address

4284 N MARYLAND AVE APT 415
PORTLAND OR
97217-3273
US

V. Phone/Fax

Practice location:
  • Phone: 503-516-3275
  • Fax:
Mailing address:
  • Phone: 503-516-3275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4222
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: