Provider Demographics
NPI:1750300281
Name:TONGUE, CHRISTOPHER K (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:K
Last Name:TONGUE
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 1:406 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7429
Mailing Address - Country:US
Mailing Address - Phone:503-318-5568
Mailing Address - Fax:503-674-9740
Practice Address - Street 1:406 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7429
Practice Address - Country:US
Practice Address - Phone:503-318-5568
Practice Address - Fax:503-674-9740
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0995103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182243Medicaid
OR115307Medicare ID - Type Unspecified