Provider Demographics
NPI:1326139965
Name:DAVIDSON, ROBERT R (MDIV, MED, LMFT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MDIV, MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45535 NW LEVI WHITE RD
Mailing Address - Street 2:
Mailing Address - City:BANKS
Mailing Address - State:OR
Mailing Address - Zip Code:97106-7434
Mailing Address - Country:US
Mailing Address - Phone:503-324-4124
Mailing Address - Fax:
Practice Address - Street 1:4110 PACIFIC AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2266
Practice Address - Country:US
Practice Address - Phone:503-357-9548
Practice Address - Fax:503-357-1158
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0095106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist