Provider Demographics
NPI:1194933267
Name:SMITH, REBEKAH CHRISTINE (PHD)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:CHRISTINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:CHRISTINE
Other - Last Name:MINNIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:18430 DEER OAK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7102
Mailing Address - Country:US
Mailing Address - Phone:503-546-9153
Mailing Address - Fax:503-239-7990
Practice Address - Street 1:1818 NE IRVING ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2238
Practice Address - Country:US
Practice Address - Phone:503-546-9153
Practice Address - Fax:503-239-7990
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1125103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical