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General NPI Number Information
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NPI Number | 1275602187
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Entity Type | Organization
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Legal Business Name | RITA MAYNARD, PSY.D.,LLC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 311 B AVE SUITE R
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-3011
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Country | US
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Telephone | 503-692-4092
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Fax |
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Provider Business Mailing Address
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Address Line | 311 B AVE SUITE R
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-3011
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Country | US
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Telephone | 503-692-4092
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. RITA MAYNARD
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Credential | PSY.D.
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Telephone | 503-692-4092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 847
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License Number State | OR
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