Provider Demographics
NPI:1245305119
Name:FREE, KURT EDWIN (PHD)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:EDWIN
Last Name:FREE
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:4900 SW GRIFFITH DR
Mailing Address - Street 2:SUITE 263
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-5607
Mailing Address - Country:US
Mailing Address - Phone:503-646-7678
Mailing Address - Fax:503-627-9145
Practice Address - Street 1:4900 SW GRIFFITH DR
Practice Address - Street 2:SUITE 263
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-5607
Practice Address - Country:US
Practice Address - Phone:503-646-7678
Practice Address - Fax:503-627-9145
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR0591103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
93-0901149OtherTAX ID NUMBER