MEDICARE: MS. TRACY BRYCE FARMER

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	1041C0700X	Clinical Social Worker	5679	OR

General Provider Information

NPI Number	:	1992145759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACY BRYCE FARMER

Provider Business Mailing Address
First Line	:	1020 SW TAYLOR ST STE 448
Second Line	:	#448
City	:	PORTLAND
State	:	OR
Zip	:	97205-2509
Country	:	US
Telephone Number	:	503-451-3267
Fax Number	:	541-668-8013

Provider Business Practice Location Address
First Line	:	1020 SW TAYLOR ST STE 448
Second Line	:	#448
City	:	PORTLAND
State	:	OR
Zip	:	97205-2509
Country	:	US
Telephone Number	:	503-451-3267
Fax Number	:	541-668-8013

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

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	02/12/2026

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