Individual
DR. ANCA MIRELA IVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1800 BLANKENSHIP RD, # 200, WEST LINN, OR 97068-4172
(503) 650-2240
(503) 650-2248
Mailing address
1800 BLANKENSHIP RD, # 200, WEST LINN, OR 97068-4172
(503) 650-2240
(503) 650-2248
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY 19910
CA
103TC1900X
Counseling Psychologist
PSY 19910
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932
LICENSE #
OR
Enumeration date
10/02/2007
Last updated
10/29/2008
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