=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467742189
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEPHEN M. HUGGINS PSY D PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2011
-----------------------------------------------------
Last Update Date | 03/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38740 PROCTOR BLVD
-----------------------------------------------------
City | SANDY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97055-8030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-939-3375
-----------------------------------------------------
Fax | 503-427-1931
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1061
-----------------------------------------------------
City | SANDY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97055-1061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-939-3375
-----------------------------------------------------
Fax | 503-427-1931
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER & PRACTITIONER
-----------------------------------------------------
Name | STEPHEN M. HUGGINS
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 503-939-3375
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 846
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------