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General NPI Number Information
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NPI Number | 1093278111
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Entity Type | Organization
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Legal Business Name | VIVA WHEATON PSYD LLC
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Dates
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Enumeration Date | 04/08/2019
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 603 E. HANCOCK ST
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City | NEWBERG
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State | OR
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Zip | 97132
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Country | US
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Telephone | 503-860-5874
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Fax |
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Provider Business Mailing Address
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Address Line | 16485 NE LEANDER DR
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City | SHERWOOD
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State | OR
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Zip | 97140-8579
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Country | US
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Telephone | 503-860-5874
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. VIVA WHEATON
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Credential | PSY.D.
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Telephone | 503-860-5874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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