Provider Demographics
NPI:1942656988
Name:WASHBURN, SAMUEL C (MA)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:C
Last Name:WASHBURN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4885 PARKVIEW DR APT I
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2437
Mailing Address - Country:US
Mailing Address - Phone:860-748-5676
Mailing Address - Fax:
Practice Address - Street 1:4885 PARKVIEW DR APT I
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2437
Practice Address - Country:US
Practice Address - Phone:860-748-5676
Practice Address - Fax:855-809-3522
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health