Healthcare Provider Details

I. General information

NPI: 1801946082
Provider Name (Legal Business Name): DEBRA R BISCHOF L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA R SIMON M.F.T.

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22300 SW BOONES FERRY RD
TUALATIN OR
97062-7373
US

IV. Provider business mailing address

PO BOX 568
CORNELIUS OR
97113-0568
US

V. Phone/Fax

Practice location:
  • Phone: 503-431-5975
  • Fax: 503-431-5976
Mailing address:
  • Phone: 503-352-8657
  • Fax: 503-352-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC3833
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: