MEDICARE: DR. PETER H. CRABTREE PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1112	OR

General Provider Information

NPI Number	:	1407073729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER H. CRABTREE PSY.D.

Provider Business Mailing Address
First Line	:	2188 SW PARK PLACE
Second Line	:	STE. 202
City	:	PORTLAND
State	:	OR
Zip	:	97205
Country	:	US
Telephone Number	:	503-274-9339
Fax Number	:

Provider Business Practice Location Address
First Line	:	2188 SW PARK PLACE
Second Line	:	STE. 202
City	:	PORTLAND
State	:	OR
Zip	:	97205
Country	:	US
Telephone Number	:	503-274-9339
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	09/12/2012

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