Healthcare Provider Details

I. General information

NPI: 1740715127
Provider Name (Legal Business Name): TAMARA RANDALL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 NW LOVEJOY ST STE 204
PORTLAND OR
97210-2863
US

IV. Provider business mailing address

222 SE 8TH AVE SUITE 212
HILLSBORO OR
97123-4218
US

V. Phone/Fax

Practice location:
  • Phone: 503-563-3420
  • Fax: 971-209-7262
Mailing address:
  • Phone: 503-352-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3785
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: