Healthcare Provider Details

I. General information

NPI: 1205710795
Provider Name (Legal Business Name): TALIA MARIE THELEN AKRE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N MAIN AVE STE 201D
GRESHAM OR
97030-7242
US

IV. Provider business mailing address

320 N MAIN AVE STE 201
GRESHAM OR
97030-7242
US

V. Phone/Fax

Practice location:
  • Phone: 917-455-1883
  • Fax:
Mailing address:
  • Phone: 917-455-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL11889
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: