Provider Demographics
NPI:1447455910
Name:WILSON, CHRISTOPHER F (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:F
Last Name:WILSON
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 1:852 SW 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1604
Mailing Address - Country:US
Mailing Address - Phone:503-887-9663
Mailing Address - Fax:503-447-9652
Practice Address - Street 1:852 SW 21ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1604
Practice Address - Country:US
Practice Address - Phone:503-887-9663
Practice Address - Fax:503-477-9651
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1696103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis