Provider Demographics
NPI:1134285992
Name:SPOTTS, STEVEN W (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:W
Last Name:SPOTTS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 SW GRIFFITH DR
Mailing Address - Street 2:STE 265
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4648
Mailing Address - Country:US
Mailing Address - Phone:503-526-9304
Mailing Address - Fax:
Practice Address - Street 1:4900 SW GRIFFITH DR
Practice Address - Street 2:STE 265
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4648
Practice Address - Country:US
Practice Address - Phone:503-526-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR944103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR011544000OtherREGENCE BCBS PROV NUM.
OR011544000OtherREGENCE BCBS PROV NUM.