Active NPI
Charles Way Harrison, PH.D.
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1437131646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1148
- Practice address
- 1210 SE Oak St
Portland, OR 97214-1427 - Phone
- (503) 975-0014
- Fax
- (503) 283-7085
- NPI assigned
- Nov 15, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1148 | OR | Primary |
Addresses
Primary practice location
1210 SE Oak St
Portland, OR 97214-1427
Mailing address
PO Box 17658
Portland, OR 97217-0658
Phone (503) 975-0014
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500612148 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1148 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437609600000",
"number": "1437131646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 17658",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972170658",
"telephone_number": "503-975-0014",
"fax_number": "503-283-7085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1210 SE OAK ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972141427",
"telephone_number": "503-975-0014",
"fax_number": "503-283-7085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRISON",
"first_name": "CHARLES",
"middle_name": "WAY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-15",
"last_updated": "2015-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "1148",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500612148",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.