MEDICARE: TAMARA LYNN MCCOLLUM

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1487907648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA LYNN MCCOLLUM

Provider Business Mailing Address
First Line	:	PO BOX 8459
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97207-8459
Country	:	US
Telephone Number	:	503-238-0769
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 SE 43RD AVE
Second Line	:	SUITE 100
City	:	PORTLAND
State	:	OR
Zip	:	97206-1600
Country	:	US
Telephone Number	:	503-238-0705
Fax Number	:

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

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	02/15/2026

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