Provider Demographics
NPI:1104909894
Name:COREY, DAVID MICHAEL (PHD, ABPP)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:COREY
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 895
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-0143
Mailing Address - Country:US
Mailing Address - Phone:503-620-8050
Mailing Address - Fax:503-620-9650
Practice Address - Street 1:5285 MEADOWS ROAD
Practice Address - Street 2:SUITE 311
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3367
Practice Address - Country:US
Practice Address - Phone:503-620-8050
Practice Address - Fax:503-620-9650
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1187103TF0200X
WAPY-1941103TF0200X
HIPSY-847103TF0200X
CAPSY-11389103TF0200X
UT6271762-2501103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic