Provider Demographics
NPI:1871862532
Name:VICTORIA RAVENSBERG, PSY.D., LLC
Entity Type:Organization
Organization Name:VICTORIA RAVENSBERG, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVENSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-536-3855
Mailing Address - Street 1:14050 SW PACIFIC HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-4890
Mailing Address - Country:US
Mailing Address - Phone:503-536-3855
Mailing Address - Fax:503-670-1034
Practice Address - Street 1:14050 SW PACIFIC HWY STE 210
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-4890
Practice Address - Country:US
Practice Address - Phone:503-536-3855
Practice Address - Fax:503-670-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1740103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty