Healthcare Provider Details

I. General information

NPI: 1831388461
Provider Name (Legal Business Name): THAEN CHIAM SAELEE PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/09/2022
Certification Date: 10/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3806 TILLICUM LN
ROSEBURG OR
97471-2271
US

IV. Provider business mailing address

1414 NW VALLEY VIEW DR # 1007
ROSEBURG OR
97471-1760
US

V. Phone/Fax

Practice location:
  • Phone: 541-900-8244
  • Fax: 541-524-4200
Mailing address:
  • Phone: 541-524-4100
  • Fax: 541-524-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3256
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: