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General NPI Number Information
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NPI Number | 1457058166
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Entity Type | Organization
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Legal Business Name | FOREST PSYCHOLOGICAL CLINIC
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 15110 BOONES FERRY RD STE 150
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-3486
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Country | US
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Telephone | 971-331-1366
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Fax | 971-715-0387
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Provider Business Mailing Address
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Address Line | 15110 BOONES FERRY RD STE 150
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-3486
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Country | US
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Telephone | 971-331-1366
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Fax | 971-715-0387
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. JAMES THATCHER
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Credential | PSYD
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Telephone | 971-353-1145
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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 |
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License Number State |
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