Provider Demographics
NPI:1841360385
Name:ROUNTREE, JAMES RICHARD (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:ROUNTREE
Suffix:
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 1:9 MONROE PARKWAY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8867
Mailing Address - Country:US
Mailing Address - Phone:503-635-9281
Mailing Address - Fax:503-635-8411
Practice Address - Street 1:9 MONROE PARKWAY
Practice Address - Street 2:SUITE 280
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8867
Practice Address - Country:US
Practice Address - Phone:503-635-9281
Practice Address - Fax:503-635-8411
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1014103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR115225Medicaid
OR115225Medicaid
0000TCHZKMedicare ID - Type Unspecified