Provider Demographics
NPI:1922038769
Name:HATTEM, ALBERTA KOCH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALBERTA
Middle Name:KOCH
Last Name:HATTEM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ABBI
Other - Middle Name:
Other - Last Name:HATTEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1319 SW COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-3159
Mailing Address - Country:US
Mailing Address - Phone:919-928-0879
Mailing Address - Fax:
Practice Address - Street 1:1319 SW COLLEGE ST
Practice Address - Street 2:SUITE 9
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-3159
Practice Address - Country:US
Practice Address - Phone:919-928-0879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLMFT410106H00000X
CAMFCC19550106H00000X
ORT0999106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11566OtherBCBSNC