Healthcare Provider Details

I. General information

NPI: 1417240466
Provider Name (Legal Business Name): TINA WEBB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SW 6TH ST
GRESHAM OR
97080-9475
US

IV. Provider business mailing address

10313 SW 69TH AVE
TIGARD OR
97223-9103
US

V. Phone/Fax

Practice location:
  • Phone: 503-726-3806
  • Fax:
Mailing address:
  • Phone: 503-726-3698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

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: