DR. CHARLES RICHARD O'BANNON (NPI# 1508856642) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508856642 |
| Entity Type | Individual |
| Full Name | DR. CHARLES RICHARD O'BANNON |
| Credential | PH.D. |
| Practice Address |
123 E Powell Blvd Ste. 212 Gresham OR 97030-7622 |
| Practice Telephone | 5036188041 |
| Practice Fax Number | 5036188052 |
| Mailing Telephone | 5036188041 |
| Mailing Fax Number | 5036188052 |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2010-10-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 1044 | OR | Behavioral Health & Social Service Providers |
| Street Address |
123 E POWELL BLVD STE. 212 |
| City | GRESHAM |
| State | OR |
| Zip Code | 97030-7622 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619304821 | Mindy Laframboise | Counselor | 123 E Powell Blvd, Suite 212, Gresham, OR 97030-7624 | 2013-10-02 |
| 1780955138 | Douglas Meacham | Massage Therapist | 123 E Powell Blvd, # 304, Gresham, OR 97030-7624 | 2012-01-17 |
| 1760791271 | Deanne Warner | Social Worker | 123 E Powell Blvd, Ste. 212, Gresham, OR 97030-7624 | 2010-09-30 |
| 1245554567 | Ryan Lee Skelton | Psychologist | 123 E Powell Blvd, 305, Gresham, OR 97030-7624 | 2010-03-15 |
| 1861638405 | Richard L Sansom | Counselor | 123 E Powell Blvd, Suite # 303, Gresham, OR 97030-7624 | 2009-01-04 |
| 1174797500 | Angela M Caiazza | Marriage & Family Therapist | 123 E Powell Blvd, Suite #303, Gresham, OR 97030-7624 | 2008-04-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174032312 | Tiffany Chen | Occupational Therapist | 304 Ne Hood Ave., Gresham, OR 97030 | 2017-09-20 |
| 1225568454 | Goldstar Vascular Access, Inc | Home Infusion | 2870 Ne Hogan Dr, Ste E #205, Gresham, OR 97030 | 2017-06-20 |
| 1861940454 | Jessica Morrow | Massage Therapist | 1748 Nw Fairview Dr., Gresham, OR 97030 | 2016-09-13 |
| 1033665898 | Bonita Baxter | Counselor | 400 Ne 7th Street, Gresham, OR 97030 | 2016-08-31 |
| 1710335484 | Ethan William Hoccom | Counselor | 1527 Ne Lamesa Place 17th St, Gresham, OR 97030 | 2016-06-02 |
| 1992159610 | Kathleen Kline, Lmt | Massage Therapist | 1217 Ne Burnside Road Suite 701-d, Gresham, OR 97030 | 2016-04-19 |
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1932568912 | Atchison Dialysis, LLC | Clinic/Center | 878 Nw Burnside Rd, Gresham, OR 97030 | 2016-02-18 |
| 1912374034 | Hilary Dawn Montgomery | Counselor | 1326 Nw Civic Dr # 5569, Gresham, OR 97030 | 2015-08-24 |
| 1992171730 | Melissa E Childs | Massage Therapist | 1217 Nw Burnside Rd Ste 701, Gresham, OR 97030 | 2015-08-17 |
| Find all providers in zip 97030 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598880411 | Elizabeth Kirkhart | Psychologist | 1375 Sw Blaine Ct, Gresham, OR 97080-5383 | 2007-03-20 |
| 1770630485 | Carol J Landesman | Psychologist | 8347 Se Orient Dr, Gresham, OR 97080-8848 | 2007-01-04 |
| 1659463727 | Jeanne G. Tyler | Psychologist | 24850 S.e. Stark St., Suite 200, Gresham, OR 97030 | 2006-09-28 |
| 1588645055 | John D Adler | Psychologist | 510 Ne Roberts Ave, #330, Gresham, OR 97030-7404 | 2005-11-10 |
| 1437778867 | Joseph Brian Rosas | Psychologist | 4101 Ne Division St Ste 100, Gresham, OR 97030-4617 | 2020-04-15 |
| 1215584776 | Patricia Renee Shimek | Psychologist | 2222 E Powell Blvd, Gresham, OR 97080-1365 | 2019-08-20 |
| 1619443934 | Rebecca Youssef | Psychologist | 440 Nw Division St, Gresham, OR 97030-5506 | 2018-10-15 |
| 1609276781 | Grant Hart | Psychologist | 2222 E Powell Blvd, Gresham, OR 97080-1365 | 2014-08-26 |
| 1063761716 | Clark Paul Rector | Psychologist | 1700 Nw Civic Dr, Gresham, OR 97030-3770 | 2012-09-09 |
| 1598882821 | Gregory G. Morse | Psychologist | 320 N Main Ave, Suite 201, Gresham, OR 97030-7242 | 2007-03-23 |
| Find all providers in GRESHAM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.