Individual provider Active NPI

Erroll E. Stephens Jr., PH.D.

  • Counseling Psychologist
  • Clackamas, OR
National Provider Identifier
1972694834
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
0580 Issued in OR
Practice address
8800 SE Sunnyside Rd
Suite 102-N
Clackamas, OR 97015-5738
Phone
(503) 786-8898
Fax
(503) 786-9004
NPI assigned
Sep 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X 0580 OR Primary

Addresses

Primary practice location

8800 SE Sunnyside Rd
Suite 102-N
Clackamas, OR 97015-5738

Mailing address

8800 SE Sunnyside Rd
Suite 102-N
Clackamas, OR 97015-5738
Phone (503) 786-8898

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)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0580ORMDCounseling Psychologist
580ORMDRegistered Dietitian

NPI Registry JSON

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": "1972694834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8800 SE SUNNYSIDE RD",
            "address_2": "SUITE 102-N",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970155738",
            "telephone_number": "503-786-8898",
            "fax_number": "503-786-9004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8800 SE SUNNYSIDE RD",
            "address_2": "SUITE 102-N",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970155738",
            "telephone_number": "503-786-8898",
            "fax_number": "503-786-9004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENS",
        "first_name": "ERROLL",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "OR",
            "license": "0580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clackamas, OR

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.