Healthcare Provider Details

I. General information

NPI: 1033414040
Provider Name (Legal Business Name): TIFFANY RAE BARR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 NE ROBERTS AVE STE 200
GRESHAM OR
97030-7484
US

IV. Provider business mailing address

510 NE ROBERTS AVE STE 200
GRESHAM OR
97030-7484
US

V. Phone/Fax

Practice location:
  • Phone: 503-799-8819
  • Fax:
Mailing address:
  • Phone: 503-799-8819
  • Fax: 503-404-3532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
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: