Provider Demographics
NPI:1841491578
Name:ROOST, NOAH LYONS (PHD)
Entity type:Individual
Prefix:DR
First Name:NOAH
Middle Name:LYONS
Last Name:ROOST
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4039 N MISSISSIPPI AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1476
Mailing Address - Country:US
Mailing Address - Phone:503-757-7260
Mailing Address - Fax:503-208-7177
Practice Address - Street 1:4039 N MISSISSIPPI AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1476
Practice Address - Country:US
Practice Address - Phone:503-757-7260
Practice Address - Fax:503-208-7177
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2013103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth