Provider Demographics
NPI:1942845805
Name:I. KEITH ORTON, PHD
Entity Type:Organization
Organization Name:I. KEITH ORTON, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:IRVING
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:ORTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-526-1461
Mailing Address - Street 1:745 NW MT WASHINGTON DR STE 301
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1576
Mailing Address - Country:US
Mailing Address - Phone:541-526-1461
Mailing Address - Fax:541-678-5513
Practice Address - Street 1:745 NW MT WASHINGTON DR STE 301
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1576
Practice Address - Country:US
Practice Address - Phone:541-526-1461
Practice Address - Fax:541-678-5513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty