Provider Demographics
NPI:1922312149
Name:KING, RICHARD BARRETT (EDD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BARRETT
Last Name:KING
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 113
Mailing Address - Street 2:
Mailing Address - City:MARYLHURST
Mailing Address - State:OR
Mailing Address - Zip Code:97036
Mailing Address - Country:US
Mailing Address - Phone:503-657-0683
Mailing Address - Fax:503-557-0579
Practice Address - Street 1:19890 ROAN CIRCLE
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068
Practice Address - Country:US
Practice Address - Phone:503-657-0683
Practice Address - Fax:503-557-0579
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR121850OtherDHS
OR2002OtherNCC