Healthcare Provider Details

I. General information

NPI: 1467805309
Provider Name (Legal Business Name): MICHELLE MADALENA TRAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 SE MORRISON ST STE 400
PORTLAND OR
97214-2344
US

IV. Provider business mailing address

847 NE 19TH AVE STE 150
PORTLAND OR
97232-2686
US

V. Phone/Fax

Practice location:
  • Phone: 503-764-9646
  • Fax:
Mailing address:
  • Phone: 503-222-0707
  • Fax: 503-764-9646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number3212
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3212
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: