MEDICARE: MS. TRESA BERRY PPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	THW000108887	OR

General Provider Information

NPI Number	:	1144119744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRESA BERRY PPS

Provider Business Mailing Address
First Line	:	PO BOX 4071
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-4071
Country	:	US
Telephone Number	:	971-610-9056
Fax Number	:

Provider Business Practice Location Address
First Line	:	5338 N BORTHWICK AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-2310
Country	:	US
Telephone Number	:	971-610-9056
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	06/30/2025

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