Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 2477 | OR |
NPI | 1023589702 |
---|---|
Provider Name | Dr. Theresa L Lafavor |
First Address | Hillsboro, OR 97123-4218 |
Second Address | Hillsboro, OR 97123-4218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2018 |
Last Update Date | 06/12/2018 |