Healthcare Provider Details

I. General information

NPI: 1972834901
Provider Name (Legal Business Name): KARLA RAE CAUSEYA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 NE BROADWAY ST SUITE 220
PORTLAND OR
97232-1284
US

IV. Provider business mailing address

1690 NE 169TH AVE #201
PORTLAND OR
97230-6089
US

V. Phone/Fax

Practice location:
  • Phone: 971-563-2317
  • Fax: 503-295-3727
Mailing address:
  • Phone: 971-563-2317
  • Fax: 503-295-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1271
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: