MEDICARE: DONALD A TRUE PH.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	0358	OR

General Provider Information

NPI Number	:	1720298235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD A TRUE PH.D.

Provider Business Mailing Address
First Line	:	5441 SW MACADAM
Second Line	:	#206
City	:	PORTLAND
State	:	OR
Zip	:	97239-3822
Country	:	US
Telephone Number	:	503-222-5922
Fax Number	:	503-222-9989

Provider Business Practice Location Address
First Line	:	5441 SW MACADAM AVE
Second Line	:	#206
City	:	PORTLAND
State	:	OR
Zip	:	97239-6106
Country	:	US
Telephone Number	:	503-222-5922
Fax Number	:	503-222-9989

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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