MEDICARE: MS. MARTRYCE ALITA TAYLOR

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1417772955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTRYCE ALITA TAYLOR

Provider Business Mailing Address
First Line	:	5425 SW HALL BLVD
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-3921
Country	:	US
Telephone Number	:	503-568-1165
Fax Number	:

Provider Business Practice Location Address
First Line	:	6635 N BALTIMORE AVE STE 280
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-5458
Country	:	US
Telephone Number	:	971-258-0112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2024
Last Update Date	:	03/18/2026

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