Provider Demographics
NPI:1528137056
Name:BORN, JAMES LEWIS (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEWIS
Last Name:BORN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36840 INDUSTRIAL WAY
Mailing Address - Street 2:SUITE F
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-9254
Mailing Address - Country:US
Mailing Address - Phone:503-668-5494
Mailing Address - Fax:503-668-6368
Practice Address - Street 1:36840 INDUSTRIAL WAY
Practice Address - Street 2:SUITE F
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-9254
Practice Address - Country:US
Practice Address - Phone:503-668-5494
Practice Address - Fax:503-668-6368
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005015536103T00000X
OK994103T00000X
CAPSY 19940103T00000X
OR1805103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR11566399OtherCAQH
OR500620806Medicaid
OR500620806Medicaid