Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 1921 | OR |
NPI | 1245408350 |
---|---|
Provider Name | Andrew William White |
First Address | Portland, OR 97239-6103 |
Second Address | Portland, OR 97239-6103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2008 |
Last Update Date | 14/05/2009 |