IndividualActive
Michael Crockett, PSYD
NPI 1780074807 · Psychologist · Gresham, OR
Provider details
- NPI number
- 1780074807
- Entity type
- Individual
- Primary specialty
- PsychologistBehavioral Health & Social Service Providers
- Credential
- PSYD
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Behavioral Health & Social Service Providers
- Cognitive & Behavioral Psychologist103TB0200X
Behavioral Health & Social Service Providers
- Counseling Psychologist103TC1900X
Behavioral Health & Social Service Providers
- Group Psychotherapy Psychologist103TP2701X
Behavioral Health & Social Service Providers
Practice location
4316 Se 182nd Ave
Gresham, OR 97030-5058
Phone: (503) 893-2249
Approximate (ZIP-level) locationGet directions
Mailing address
2315 Ne Francis Ct
Gresham, OR 97030-3155
Registry dates
- Enumerated
- 2015-01-27
- Last updated
- 2022-03-02
- Certified
- 2022-03-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.