Individual
MRS. TINA HAN BOUILLION
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CADC II, LPC
Contact information
Practice address
333 NE RUSSELL ST STE 209, PORTLAND, OR 97212-3762
(971) 291-0626
(458) 224-0137
Mailing address
5304 SE 44TH AVE, PORTLAND, OR 97206-5737
(971) 291-0626
(458) 224-0137
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C3283
OR
101YP2500X
Professional Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500762021
—
OR
Enumeration date
02/25/2009
Last updated
06/11/2019
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