Healthcare Provider Details

I. General information

NPI: 1316178106
Provider Name (Legal Business Name): CHRISTOPHER LEE THOEN PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8770 SW SCOFFINS ST
TIGARD OR
97223-6226
US

IV. Provider business mailing address

PO BOX 82507
PORTLAND OR
97282-0507
US

V. Phone/Fax

Practice location:
  • Phone: 503-684-1424
  • Fax: 503-684-1425
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number200741788RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200950069NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: