Healthcare Provider Details

I. General information

NPI: 1043306772
Provider Name (Legal Business Name): TANYA R THOMPSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NW PROFESSIONAL DR STE 101
CORVALLIS OR
97330-3891
US

IV. Provider business mailing address

PO BOX 100
ALBANY OR
97321-0031
US

V. Phone/Fax

Practice location:
  • Phone: 541-257-5500
  • Fax: 541-286-4140
Mailing address:
  • Phone: 541-967-3866
  • Fax: 541-928-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3150
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: