Provider Demographics
NPI:1558496299
Name:VERSCHUYL, CHRISTOPHER JAN (MSW, CSWA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JAN
Last Name:VERSCHUYL
Suffix:
Gender:M
Credentials:MSW, CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 SE 121ST AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-4066
Mailing Address - Country:US
Mailing Address - Phone:503-335-5975
Mailing Address - Fax:503-335-5974
Practice Address - Street 1:2410 SE 121ST AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-4066
Practice Address - Country:US
Practice Address - Phone:503-335-5975
Practice Address - Fax:503-335-5974
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCSWA #A19881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical