Provider Demographics
NPI:1205023645
Name:RICKS WARREN PH.D., ABPP, PC
Entity type:Organization
Organization Name:RICKS WARREN PH.D., ABPP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKS
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-635-8710
Mailing Address - Street 1:4550 S.W. KRUSE WAY #225
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-635-8710
Mailing Address - Fax:503-635-0583
Practice Address - Street 1:4550 KRUSE WAY STE 225
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2586
Practice Address - Country:US
Practice Address - Phone:503-635-8710
Practice Address - Fax:503-635-0583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR422103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty