| Organization Name: | CHARLES R OBANNON |
| NPI Number: | 1720496730 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES RICHARD O'BANNON (LICENSED PSYCHOLOGIST / OWNER) |
| Mailing Address: | 31090 Se Division Dr Troutdale |
| State: | OR US |
| Postal Code: | 970609451 |
| Phone Number: | 5036188041 |
| Fax Number: | 5036188052 |
| NPI Enumeration Date: | 07/23/2014 |
| NPI Last Update Date: | 09/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |