=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295878239
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY HACOPIAN PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 09/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10700 SW BEAVERTON HILLSDALE HWY STE 450
-----------------------------------------------------
City | BEAVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97005-4736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-928-6624
-----------------------------------------------------
Fax | 866-803-2248
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14588 SW SHOUE DR
-----------------------------------------------------
City | TIGARD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-438-6671
-----------------------------------------------------
Fax | 866-803-2248
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------