Healthcare Provider Details

I. General information

NPI: 1811163801
Provider Name (Legal Business Name): TARINA ROSS TONGE MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 03/14/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 NE COURTNEY DR
BEND OR
97701-7636
US

IV. Provider business mailing address

16378 SKYLINERS RD
BEND OR
97703-5202
US

V. Phone/Fax

Practice location:
  • Phone: 541-550-5502
  • Fax:
Mailing address:
  • Phone: 541-382-0973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL7884
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: