Individual
PHYLLIS M RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1112 NE 21ST AVE, SUITE 5, PORTLAND, OR 97232-2595
(503) 281-1897
(503) 281-4862
Mailing address
1112 NE 21ST AVE, SUITE 5, PORTLAND, OR 97232
(503) 281-1897
(503) 281-4862
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
668
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
Enumeration date
12/20/2006
Last updated
12/19/2007
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