Provider Demographics
NPI:1154561140
Name:F THACHER CARTER PSYD PC
Entity type:Organization
Organization Name:F THACHER CARTER PSYD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:THACHER
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD,
Authorized Official - Phone:541-962-7491
Mailing Address - Street 1:63670 OWSLEY CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-5177
Mailing Address - Country:US
Mailing Address - Phone:541-962-7491
Mailing Address - Fax:
Practice Address - Street 1:105 FIR ST
Practice Address - Street 2:SUITE 332
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2661
Practice Address - Country:US
Practice Address - Phone:541-910-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1172103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty