Black, Tanya L

Black, Tanya L is an individual health care provider with primary practice located at 1310 Sw 17Th Ave , Portland OR 97201-2522. She recently has 3 registered licenses in different health care specialties including Other Service Providers / Peer Specialist, Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Black, Tanya L can be contacted via phone (503) 231-2641.

Contact Information

Primary practice address
1310 Sw 17Th Ave Portland OR 97201-2522
Phone: (503) 231-2641
Fax: (503) 467-4077
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Peer Specialist 175T00000X THW000001319 Oregon
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 23-QMHA-R-3628 Oregon
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 16-CRM-033 Oregon

Profile Details

NPI number 1801242730
LBN Legal business name Black, Tanya L
Credentials CRM/PSS/QMHA-R
Entity Individual
Sole proprietor 1 No
Enumeration date May 10th, 2016
Last updated Apr 26th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801242730 NPPES
Oregon MEDICAID 500730810
Oregon MEDICAID 500819326

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