Provider Demographics
NPI:1134673924
Name:DO, KRISTIN MARY (PSY D)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARY
Last Name:DO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MARY
Other - Last Name:NICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:7505 SW BEVELAND RD STE 205
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8682
Mailing Address - Country:US
Mailing Address - Phone:503-888-4951
Mailing Address - Fax:971-217-9029
Practice Address - Street 1:7505 SW BEVELAND RD STE 205
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223
Practice Address - Country:US
Practice Address - Phone:503-888-4951
Practice Address - Fax:971-217-9029
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3141103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist