Provider Demographics
NPI:1477124261
Name:FIRST RESPONDER PSYCHOLOGY
Entity Type:Organization
Organization Name:FIRST RESPONDER PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CONN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:971-250-1519
Mailing Address - Street 1:12725 SW MILLIKAN WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1687
Mailing Address - Country:US
Mailing Address - Phone:971-250-1519
Mailing Address - Fax:971-223-0950
Practice Address - Street 1:12725 SW MILLIKAN WAY STE 300
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1687
Practice Address - Country:US
Practice Address - Phone:971-250-1519
Practice Address - Fax:971-223-0950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty