Individual
DR. CHARLES RICHARD O'BANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
123 E POWELL BLVD, STE. 212, GRESHAM, OR 97030-7622
(503) 618-8041
(503) 618-8052
Mailing address
123 E POWELL BLVD, STE. 212, GRESHAM, OR 97030-7622
(503) 618-8041
(503) 618-8052
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1044
OR
Other
Enumeration date
10/27/2005
Last updated
10/25/2010
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