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NPI Code Detail

MEDICARE: TYLEE COOPER CLARK CSWA

MEDICARE: TYLEE COOPER CLARK CSWA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorA15351OR
21041C0700XClinical Social WorkerA15351OR

General Provider Information

NPI Number : 1043825169
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLEE COOPER CLARK CSWA
Provider Business Mailing Address
First Line : 2301 COVE AVE
Second Line :
City : LA GRANDE
State : OR
Zip : 97850-3906
Country : US
Telephone Number : 541-962-8800
Fax Number : 541-963-5272
Provider Business Practice Location Address
First Line : 11740 SW 68TH PKWY STE 200
Second Line :
City : TIGARD
State : OR
Zip : 97223-9058
Country : US
Telephone Number : 425-477-4216
Fax Number : 971-352-6984
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2020
Last Update Date : 05/26/2026

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Directions to “ TYLEE COOPER CLARK CSWA” Practice Location

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