Healthcare Provider Details

I. General information

NPI: 1245472182
Provider Name (Legal Business Name): TARA ANNETTE BROOKS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA A HAMILTON

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 NW DIVISION ST
GRESHAM OR
97030-5523
US

IV. Provider business mailing address

1776 SW MADISON ST
PORTLAND OR
97205-1715
US

V. Phone/Fax

Practice location:
  • Phone: 503-231-2641
  • Fax: 503-231-1654
Mailing address:
  • Phone: 503-224-1044
  • Fax: 503-621-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC4119
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: