Provider Demographics
NPI:1750315891
Name:DOPPELT, LEE HOWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:HOWARD
Last Name:DOPPELT
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 1:4550 KRUSE WAY
Mailing Address - Street 2:SUITE # 225
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3594
Mailing Address - Country:US
Mailing Address - Phone:503-697-0600
Mailing Address - Fax:503-635-0583
Practice Address - Street 1:4550 KRUSE WAY
Practice Address - Street 2:SUITE # 225
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3594
Practice Address - Country:US
Practice Address - Phone:503-697-0600
Practice Address - Fax:503-635-0583
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR669103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist