Provider Demographics
NPI:1821472242
Name:KHOURY, CAITLIN KELLER (PHD, BCBA)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:KELLER
Last Name:KHOURY
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 SW BARNES RD STE 301
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6670
Mailing Address - Country:US
Mailing Address - Phone:503-535-6300
Mailing Address - Fax:503-297-7975
Practice Address - Street 1:9555 SW BARNES RD STE 301
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6670
Practice Address - Country:US
Practice Address - Phone:503-535-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR103K00000X
OR2831103T00000X
NE10578101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health