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General NPI Number Information
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NPI Number | 1487407920
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Entity Type | Individual
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Provider Name | TASHA RENEE PHILLIPS PSYD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2024
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 3181 SW SAM JACKSON PARK RD
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-494-2999
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Fax | 503-494-2391
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Provider Business Mailing Address
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Address Line | 1400 SW 5TH AVE STE 500
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City | PORTLAND
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State | OR
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Zip | 97201-5537
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Country | US
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Telephone | 866-617-6855
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Fax | 503-346-8015
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2498
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License Number State | OR
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