Healthcare Provider Details

I. General information

NPI: 1154691053
Provider Name (Legal Business Name): TIA LOUISE RICH CPM, LMT, LC, CIEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TINA LOUISE RICH CPM, LMT, LC, CIEM

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11297 SW TONQUIN PL
SHERWOOD OR
97140-9546
US

IV. Provider business mailing address

11297 SW TONQUIN PL
SHERWOOD OR
97140-9546
US

V. Phone/Fax

Practice location:
  • Phone: 971-533-6496
  • Fax:
Mailing address:
  • Phone: 971-533-6496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number26511
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: