Healthcare Provider Details

I. General information

NPI: 1184871949
Provider Name (Legal Business Name): MAYA BRISTOW KLEIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2008
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10260 SW GREENBURG RD STE 400
TIGARD OR
97223-5514
US

IV. Provider business mailing address

11403 W BERNARDO CT # 205
SAN DIEGO CA
92127-1639
US

V. Phone/Fax

Practice location:
  • Phone: 503-244-7674
  • Fax:
Mailing address:
  • Phone: 760-846-8852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2901
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY26592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: