Charles R Obannon

NPI #1720496730 in Troutdale, Oregon

Provider Information

NPI Number: 1720496730
Entity Type: Organization
Organization Name: Charles R Obannon
Primary Specialty: Psychologist
Enumeration Date: Jul 23, 2014
Last Updated: Sep 25, 2015

Practice Location

Address: 31090 SE DIVISION DR
City: Troutdale
State: Oregon
ZIP Code: 97060-9451
Phone: (503) 618-8041

Authorized Official

Name: DR. CHARLES RICHARD O'BANNON, PH.D.
Title: LICENSED PSYCHOLOGIST / OWNER
Phone: (503) 618-8041

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X
Psychologist	103T00000X	Primary

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