Organization
SISU HEALING PARTNERS
Active
Other names
not applicable
Organization subpart
No
Provider details
NPI number
Authorized official
TARA RAYBURN LICSWA, QMHP,CADCIII (FOUNDER & DIRECTOR)
(971) 645-0148
Entity
Organization
Contact information
Practice address
1722 NW RALEIGH ST SPC 410, PORTLAND, OR 97209-1754
(503) 847-9836
Mailing address
1722 NW RALEIGH ST UNIT 410, MAILBOX 304, PORTLAND, OR 97209
(503) 847-9836
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134584527
NPI NUMBER
OR
Enumeration date
12/16/2021
Last updated
12/16/2021
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