Provider Demographics
NPI:1043441389
Name:ORTON, IRVING KEITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:KEITH
Last Name:ORTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:I.
Other - Middle Name:KEITH
Other - Last Name:ORTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:745 NW MT WASHINGTON DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1574
Mailing Address - Country:US
Mailing Address - Phone:541-526-1461
Mailing Address - Fax:541-318-4883
Practice Address - Street 1:745 NW MT WASHINGTON DR
Practice Address - Street 2:SUITE 303
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1574
Practice Address - Country:US
Practice Address - Phone:541-526-1461
Practice Address - Fax:541-318-4883
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR490103TC0700X
103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth