Provider Demographics
NPI:1972694834
Name:STEPHENS, ERROLL E JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERROLL
Middle Name:E
Last Name:STEPHENS
Suffix:JR
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 1:8800 SE SUNNYSIDE RD
Mailing Address - Street 2:SUITE 102-N
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5738
Mailing Address - Country:US
Mailing Address - Phone:503-786-8898
Mailing Address - Fax:503-786-9004
Practice Address - Street 1:8800 SE SUNNYSIDE RD
Practice Address - Street 2:SUITE 102-N
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5738
Practice Address - Country:US
Practice Address - Phone:503-786-8898
Practice Address - Fax:503-786-9004
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0580103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000TCPBTMedicare ID - Type Unspecified