Provider Demographics
NPI:1982737532
Name:SEBASTIAN, LORAH A (PHD)
Entity Type:Individual
Prefix:
First Name:LORAH
Middle Name:A
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 SW MACADAM
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3821
Mailing Address - Country:US
Mailing Address - Phone:503-221-6946
Mailing Address - Fax:503-222-5480
Practice Address - Street 1:5441 SW MACADAM
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3821
Practice Address - Country:US
Practice Address - Phone:503-221-6946
Practice Address - Fax:503-222-5480
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR631103T00000X
WAPY00003429103T00000X
HIPSY936103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist