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General NPI Number Information
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NPI Number | 1194363945
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Entity Type | Individual
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Provider Name | ZACHARY THOMAS STINE PSYD
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Gender | Male
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 6400 SE LAKE RD STE 325
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City | MILWAUKIE
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State | OR
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Zip | 97222-2185
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Country | US
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Telephone | 503-786-1711
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Fax | 503-786-9919
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Provider Business Mailing Address
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Address Line | 6400 SE LAKE RD STE 325
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City | MILWAUKIE
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State | OR
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Zip | 97222-2185
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Country | US
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Telephone | 503-786-1711
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Fax | 503-786-9919
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3796
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License Number State | OR
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