Provider Demographics
NPI:1083968994
Name:DEBAR, LYNN LARSON (PHD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:LARSON
Last Name:DEBAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 N INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1110
Mailing Address - Country:US
Mailing Address - Phone:503-335-6796
Mailing Address - Fax:503-335-6311
Practice Address - Street 1:3800 N INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1110
Practice Address - Country:US
Practice Address - Phone:503-335-6796
Practice Address - Fax:503-335-6311
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical