Provider Demographics
NPI:1982246005
Name:KRISTIN DO, PSYD, LLC
Entity Type:Organization
Organization Name:KRISTIN DO, PSYD, LLC
Other - Org Name:KRISTIN DO, PSYD
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-888-4951
Mailing Address - Street 1:7505 SW BEVELAND ST., STE 205
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8682
Mailing Address - Country:US
Mailing Address - Phone:503-888-4951
Mailing Address - Fax:971-217-3924
Practice Address - Street 1:7505 SW BEVELAND ST., STE 205
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8682
Practice Address - Country:US
Practice Address - Phone:503-888-4951
Practice Address - Fax:971-217-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty