Healthcare Provider Details

I. General information

NPI: 1306770078
Provider Name (Legal Business Name): TANYA CORKUM LPC ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NW 119TH AVE
PORTLAND OR
97229-4704
US

IV. Provider business mailing address

15060 NW CENTRAL DR APT 1101
PORTLAND OR
97229-0971
US

V. Phone/Fax

Practice location:
  • Phone: 858-504-0875
  • Fax:
Mailing address:
  • Phone: 858-504-0875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberR9253
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: