| Charles R Obannon | |
|
31090 Se Division Dr Troutdale OR 97060-9451 | |
| (503) 618-8041 | |
| (503) 618-8052 |
| Full Name | Charles R Obannon |
|---|---|
| Speciality | Psychologist |
| Location | 31090 Se Division Dr, Troutdale, Oregon |
| Authorized Official Name and Position | Charles Richard O'bannon (LICENSED PSYCHOLOGIST / OWNER) |
| Authorized Official Contact | 5036188041 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles R Obannon 31090 Se Division Dr Troutdale OR 97060-9451 Ph: (503) 618-8041 | Charles R Obannon 31090 Se Division Dr Troutdale OR 97060-9451 Ph: (503) 618-8041 |
| NPI Number | 1720496730 |
|---|---|
| Provider Enumeration Date | 07/23/2014 |
| Last Update Date | 09/25/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720496730 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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