Healthcare Provider Details

I. General information

NPI: 1417866559
Provider Name (Legal Business Name): CHAD DANFORD HARRISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46823 SUNSET AVE
WESTFIR OR
97492-9703
US

IV. Provider business mailing address

46823 SUNSET AVE
WESTFIR OR
97492-9703
US

V. Phone/Fax

Practice location:
  • Phone: 541-503-8033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number000054556
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number119273
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: