Healthcare Provider Details

I. General information

NPI: 1295659845
Provider Name (Legal Business Name): TANYA FALK QMHA-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 NE BROADWAY ST
PORTLAND OR
97232-1823
US

IV. Provider business mailing address

211 SE CARUTHERS ST
PORTLAND OR
97214-4502
US

V. Phone/Fax

Practice location:
  • Phone: 503-548-0346
  • Fax: 503-232-5959
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 Number26-QMHA-R-8933
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: