Provider Demographics
NPI:1457058166
Name:FOREST PSYCHOLOGICAL CLINIC
Entity Type:Organization
Organization Name:FOREST PSYCHOLOGICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:THATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:971-353-1145
Mailing Address - Street 1:15110 BOONES FERRY RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3486
Mailing Address - Country:US
Mailing Address - Phone:971-331-1366
Mailing Address - Fax:971-715-0387
Practice Address - Street 1:15110 BOONES FERRY RD STE 150
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3486
Practice Address - Country:US
Practice Address - Phone:971-331-1366
Practice Address - Fax:971-715-0387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty