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General NPI Number Information
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NPI Number | 1629812250
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Entity Type | Individual
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Provider Name | JOSHUA TILLER-ORMORD PHD
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Gender | Male
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Dates
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Enumeration Date | 06/19/2024
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 700 SW CAMPUS DR
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City | PORTLAND
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State | OR
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Zip | 97239-3107
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Country | US
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Telephone | 503-346-0640
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4399
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City | PORTLAND
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State | OR
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Zip | 97208-4399
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Country | US
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Telephone |
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4047
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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