Provider Demographics
NPI:1104662055
Name:OAK & FERN PSYCHOTHERAPY
Entity type:Organization
Organization Name:OAK & FERN PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOLLARS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-884-6921
Mailing Address - Street 1:9500 SW BARBUR BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5425
Mailing Address - Country:US
Mailing Address - Phone:503-910-6379
Mailing Address - Fax:
Practice Address - Street 1:9500 SW BARBUR BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5425
Practice Address - Country:US
Practice Address - Phone:503-884-6921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR60054OtherAETNA