Provider Demographics
NPI:1104038579
Name:LEBRAY, PETER RYLAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:RYLAN
Last Name:LEBRAY
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 1:20580 SW 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8583
Mailing Address - Country:US
Mailing Address - Phone:503-781-8718
Mailing Address - Fax:
Practice Address - Street 1:20580 SW 104TH AVE
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8583
Practice Address - Country:US
Practice Address - Phone:503-781-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR287103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical