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NPI Code Detail

MEDICARE: TARYN HOLM

MEDICARE: TARYN HOLM
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1679261556
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARYN HOLM
Provider Business Mailing Address
First Line : 2256 SE CARUTHERS ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-5518
Country : US
Telephone Number : 971-322-5062
Fax Number :
Provider Business Practice Location Address
First Line : 10580 SW MCDONALD ST STE 202
Second Line :
City : TIGARD
State : OR
Zip : 97224-4800
Country : US
Telephone Number : 971-242-4155
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2023
Last Update Date : 04/27/2023

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