Provider Demographics
NPI:1922047596
Name:TOBIN, STEPHAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:
Last Name:TOBIN
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 1:19025 NIXON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-2154
Mailing Address - Country:US
Mailing Address - Phone:503-697-0701
Mailing Address - Fax:503-636-0719
Practice Address - Street 1:19025 NIXON AVE
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-2154
Practice Address - Country:US
Practice Address - Phone:503-697-0701
Practice Address - Fax:503-636-0719
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA400002990103TB0200X
OR1610103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
118966Medicare ID - Type Unspecified