Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2135 | OR |
N | 103T00000X | Psychologist | 2135 | OR |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2135 | OR |
Y | 103G00000X | Clinical Psychologist | 2135 | OR |
Y | 103TC0700X | Clinical Psychologist | 2135 | OR |
N | 103TM1800X | Intellectual & Developmental Disabilities | 2135 | OR |
N | 103TP2701X | Group Psychotherapist | 2135 | OR |
NPI | 1124309877 |
---|---|
Provider Name | Dr. William Weymouth |
First Address | Portland, OR 97202-1651 |
Second Address | Portland, OR 97202-1651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2011 |
Last Update Date | 07/09/2011 |