Healthcare Provider Details

I. General information

NPI: 1689538241
Provider Name (Legal Business Name): NICOLE TABOR COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 SW MASTERS LOOP APT 202
ALOHA OR
97078-1429
US

IV. Provider business mailing address

4519 SW MASTERS LOOP APT 202
ALOHA OR
97078-1429
US

V. Phone/Fax

Practice location:
  • Phone: 503-713-7583
  • Fax:
Mailing address:
  • Phone: 503-713-7583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: NICOLE R TABOR
Title or Position: OWNER/LPC
Credential: LPC
Phone: 503-713-7583