Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2555 | OR |
Y | 103T00000X | Psychologist | 2555 | OR |
N | 103G00000X | Clinical Psychologist | 2555 | OR |
N | 103TC0700X | Clinical Psychologist | 2555 | OR |
N | 103TH0004X | Health Psychologist | 2555 | OR |
NPI | 1013386937 |
---|---|
Provider Name | Dr. Timothy Wright |
First Address | Portland, OR 97282-1152 |
Second Address | Portland, OR 97239-2964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2015 |
Last Update Date | 21/09/2015 |