Provider Demographics
NPI:1235504655
Name:TORRES SPRAUER, OLIVIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:
Last Name:TORRES SPRAUER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3235 NE 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1143
Mailing Address - Country:US
Mailing Address - Phone:503-773-4140
Mailing Address - Fax:503-427-7884
Practice Address - Street 1:833 KENMOOR AVE SE STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2390
Practice Address - Country:US
Practice Address - Phone:616-227-3423
Practice Address - Fax:616-965-3968
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018177103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty