Provider Demographics
NPI:1063473353
Name:PORTMAN, THOMAS CHRISTOPHER (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHRISTOPHER
Last Name:PORTMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 13TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7154
Mailing Address - Country:US
Mailing Address - Phone:360-733-4502
Mailing Address - Fax:360-733-7594
Practice Address - Street 1:1118 FINNEGAN WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-6622
Practice Address - Country:US
Practice Address - Phone:360-733-4502
Practice Address - Fax:360-733-7594
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1615103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P03410Medicare UPIN
WAAB14817Medicare ID - Type Unspecified