Active NPI
Holly Hetrick, PSY D
- Psychologist
- Newberg, OR
National Provider Identifier
1861634255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1990
- Practice address
- 442 Villa Rd
Newberg, OR 97132-1856 - Phone
- (503) 610-0773
- NPI assigned
- Mar 31, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1990 | OR | Primary |
| Cognitive & Behavioral Psychologist | 103TB0200X | 1990 | OR | |
| Counseling Psychologist | 103TC1900X | 1990 | OR | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 1990 | OR | |
| Group Psychotherapy Psychologist | 103TP2701X | 1990 | OR |
Addresses
Primary practice location
442 Villa Rd
Newberg, OR 97132-1856
Mailing address
901 Brutscher St # D193
Newberg, OR 97132-6096
Phone (503) 610-0773
Other practice location 1
16535 SW TV Hwy
Beaverton, OR 97006-9922
Phone (503) 649-5651
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1990 | OR | MD | Group Psychotherapy Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1238457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1861634255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 BRUTSCHER ST # D193",
"city": "NEWBERG",
"state": "OR",
"postal_code": "971326096",
"telephone_number": "503-610-0773"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "442 VILLA RD",
"city": "NEWBERG",
"state": "OR",
"postal_code": "971321856",
"telephone_number": "503-610-0773"
}
],
"practiceLocations": [
{
"address_1": "16535 SW TV Hwy",
"address_purpose": "LOCATION",
"city": "Beaverton",
"state": "OR",
"postal_code": "970069922",
"country_code": "US",
"telephone_number": "503-649-5651",
"fax_number": "503-649-7405",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HETRICK",
"first_name": "HOLLY",
"name_prefix": "Dr.",
"credential": "PSY D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-03-31",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "1990",
"primary": true
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "OR",
"license": "1990",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "OR",
"license": "1990",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "OR",
"license": "1990",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "OR",
"license": "1990",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newberg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.