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General NPI Number Information
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NPI Number | 1437131646
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Entity Type | Individual
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Provider Name | CHARLES WAY HARRISON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 1210 SE OAK ST
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City | PORTLAND
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State | OR
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Zip | 97214-1427
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Country | US
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Telephone | 503-975-0014
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Fax | 503-283-7085
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Provider Business Mailing Address
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Address Line | PO BOX 17658
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City | PORTLAND
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State | OR
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Zip | 97217-0658
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Country | US
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Telephone | 503-975-0014
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Fax | 503-283-7085
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1148
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License Number State | OR
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