Organization
THINKBIG, LLC, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. S L DEFAZIO M.S. (CONSULTING PSYCHOLOGIST)
(971) 225-0114
Entity
Organization
Contact information
Practice address
16225 SW GAGE LN, BEAVERTON, OR 97006-5580
(971) 225-0114
(270) 626-2725
Mailing address
16225 SW GAGE LN, BEAVERTON, OR 97006-5580
(971) 225-0114
(270) 626-2725
Taxonomy
Speciality
Code
Description
License number
State
103TE1100X
Exercise & Sports Psychologist
—
—
103TH0004X
Health Psychologist
—
OR
133NN1002X
Nutrition Education Nutritionist
—
OR
251S00000X
Community/Behavioral Health Agency
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
MN
Other
Enumeration date
07/16/2016
Last updated
07/16/2016
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