Tilson, Mark David
Tilson, Mark David is an sole proprietor health care provider with primary practice located at 1015 Nw 22Nd Ave Rio - 5 East, Portland OR 97210-3025. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Neuropsychologist, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Rehabilitation. Behavioral Health & Social Service Providers / Clinical Neuropsychologist is his primary health care specialty. Tilson, Mark David can be contacted via phone (503) 413-7662.Contact Information
Primary practice address
1015 Nw 22Nd Ave Rio - 5 East
Portland OR 97210-3025
Phone: (503) 413-7662
Fax: (503) 413-8103
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Behavioral Health & Social Service Providers / Clinical Neuropsychologist | 103G00000X | 826 | Oregon |
Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 826 | Oregon |
Behavioral Health & Social Service Providers / Rehabilitation | 103TR0400X | 826 | Oregon |
Profile Details
NPI number | 1134345523 |
---|---|
LBN Legal business name | Tilson, Mark David |
Credentials | PH.D. |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Apr 17th, 2007 |
Last updated | Jul 9th, 2007 - about 17 years ago |
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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1134345523 | NPPES |
Oregon | MEDICAID | 079009 |
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