Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1972 | OR |
Y | 103TC0700X | Clinical Psychologist | 1972 | OR |
N | 103G00000X | Clinical Psychologist | 1972 | OR |
N | 103TC0700X | Clinical Psychologist | 1972 | OR |
N | 103TP2701X | Group Psychotherapist | 1972 | OR |
N | 103TR0400X | Rehabilitation Psychologist | 1972 | OR |
NPI | 1619103199 |
---|---|
Provider Name | Bj Scott |
First Address | Portland, OR 97210-3025 |
Second Address | Portland, OR 97212-5321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2009 |
Last Update Date | 03/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R161292 | (05) | OR |