Provider Demographics
NPI:1952380982
Name:EACRET, DARREL WORTHLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DARREL
Middle Name:WORTHLEY
Last Name:EACRET
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 1:15964 LWR. BOONES FERRY RD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4361
Mailing Address - Country:US
Mailing Address - Phone:971-226-5679
Mailing Address - Fax:503-675-1836
Practice Address - Street 1:15964 LWR. BOONES FERRY RD.
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4361
Practice Address - Country:US
Practice Address - Phone:971-226-5679
Practice Address - Fax:503-675-1836
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR0721103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist