Provider Demographics
NPI:1598880411
Name:KIRKHART, ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:KIRKHART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 SW BLAINE CT
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-5383
Mailing Address - Country:US
Mailing Address - Phone:503-661-4126
Mailing Address - Fax:503-661-5304
Practice Address - Street 1:1375 SW BLAINE CT
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-5383
Practice Address - Country:US
Practice Address - Phone:503-661-4126
Practice Address - Fax:503-661-5304
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1082103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR117873OtherMHN
OR073356OtherVALUE OPTIONS
OR12096895OtherMULTIPLAN
OR5289377OtherCCN NETWORK
ORR0000TCKBZMedicare ID - Type Unspecified