Healthcare Provider Details

I. General information

NPI: 1578409702
Provider Name (Legal Business Name): DAUSON BAMWINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 SW CENTER ST. TIGARD, OR 97223
TIGARD OR
97223
US

IV. Provider business mailing address

8915 SW CENTER ST. TIGARD, OR 97223
TIGARD OR
97223
US

V. Phone/Fax

Practice location:
  • Phone: 503-726-3740
  • Fax:
Mailing address:
  • Phone: 503-726-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: