Provider Demographics
NPI:1629079835
Name:FARRENKOPF, TONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:FARRENKOPF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2256 NW PETTYGROVE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2608
Mailing Address - Country:US
Mailing Address - Phone:503-225-0498
Mailing Address - Fax:503-225-0499
Practice Address - Street 1:2256 NW PETTYGROVE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2608
Practice Address - Country:US
Practice Address - Phone:503-225-0498
Practice Address - Fax:503-225-0499
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR643103TC0700X
CAPSY4779103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000TCGSNMedicare ID - Type Unspecified