Provider Demographics
NPI:1134218118
Name:PROPST, LOIS REBECCA (PHD)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:REBECCA
Last Name:PROPST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9310 SW PLACE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6456
Mailing Address - Country:US
Mailing Address - Phone:503-244-4660
Mailing Address - Fax:503-244-8443
Practice Address - Street 1:9310 SW PLACE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-6456
Practice Address - Country:US
Practice Address - Phone:503-244-4660
Practice Address - Fax:503-244-8443
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR483103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical