Individual
DR. RORY FLEMING RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., FICPPM
Contact information
Practice address
4466 NE DEVILS LAKE BLVD, SUITE A, LINCOLN CITY, OR 97367-5197
(541) 994-4462
(541) 994-6329
Mailing address
P.O. BOX 109, LINCOLN CITY, OR 97367-0109
(541) 994-4462
(541) 994-6329
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C0068
OR
103G00000X
Clinical Neuropsychologist
1249
OR
103T00000X
Psychologist
Primary
1249
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
069078000
REGENCE BLUE CROSS BLUE S
OR
01
—
090021822
STATE OF OREGON DDS
OR
05
—
092951
—
OR
05
—
150576
—
OR
01
—
171641
MENTAL HEALTH NETWORK
OR
01
—
OR00543
MEDICARE NORIDIAN EDI
—
01
—
R 7WBQ0
PACC HMO
OR
Enumeration date
11/22/2005
Last updated
03/02/2009
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