1780730705 NPI number — MS. KATHERIN THOMSON VAN DOREN MA COUNSELING ART TX

Table of content: MS. KATHERIN THOMSON VAN DOREN MA COUNSELING ART TX (NPI 1780730705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780730705 NPI number — MS. KATHERIN THOMSON VAN DOREN MA COUNSELING ART TX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN DOREN
Provider First Name:
KATHERIN
Provider Middle Name:
THOMSON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA COUNSELING ART TX
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PHIPPS
Provider Other First Name:
KATE
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MAAT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780730705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1315 SE 35TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97214-4235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-212-2258
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4790 N LOMBARD ST
Provider Second Line Business Practice Location Address:
MORRISON CENTER
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97203-4565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-258-4557
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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