Robert R. Davidson, M.DIV., M.ED., LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

T0095 Issued in OR

Practice address

4110 Pacific Ave
Suite 202
Forest Grove, OR 97116-2266

Phone

(503) 357-9548

Fax

(503) 357-1158

NPI assigned

Sep 27, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 11, 2024 through Jan 11, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Institute, P.C.

  • Mental Health Counselor
  • Forest Grove, OR
  • NPI 1225244304
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1326139965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45535 NW LEVI WHITE RD",
            "city": "BANKS",
            "state": "OR",
            "postal_code": "971067434",
            "telephone_number": "503-324-4124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 PACIFIC AVE",
            "address_2": "SUITE 202",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971162266",
            "telephone_number": "503-357-9548",
            "fax_number": "503-357-1158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "ROBERT",
        "middle_name": "R.",
        "credential": "M.DIV., M.ED., LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "OR",
            "license": "T0095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Farah Grace Custodio
• Custom Care Physical Therapy, LLC.
• Thuy Xuan Dang
• Yen Dang
• Maud Darger, BSN, RN, PA-STUDENT
• Rosaisela Delgado Ferreyra
• Erin Michelle Derosia, P.T.
• Steven Raymond Dierickx, DMD
• Margaret Digiulian
• Rachel Lucinda Erin Dilly, SLP

• Marriage & Family Therapist in Forest Grove, OR
• Providers in Forest Grove, OR by specialty
• Marriage & Family Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.