Healthcare Provider Details

I. General information

NPI: 1013471549
Provider Name (Legal Business Name): TARA JOELLE WALKER QMHP, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 NW DIVISION ST
GRESHAM OR
97030-5523
US

IV. Provider business mailing address

211 SE CARUTHERS ST
PORTLAND OR
97214-4502
US

V. Phone/Fax

Practice location:
  • Phone: 503-231-2641
  • Fax:
Mailing address:
  • Phone: 971-217-9008
  • Fax: 971-260-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19-QMHPC-00421
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR12540
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: