Provider Demographics
NPI:1821025495
Name:PATRICK, LUKE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:E
Last Name:PATRICK
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 1:5739 SW TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1257
Mailing Address - Country:US
Mailing Address - Phone:503-452-4179
Mailing Address - Fax:
Practice Address - Street 1:12250 SW GARDEN PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8246
Practice Address - Country:US
Practice Address - Phone:503-684-7246
Practice Address - Fax:503-624-0724
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1491103TE1100X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service