Individual
TYLER WHITMAN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
1827 NE 44TH AVE STE 390, PORTLAND, OR 97213-1461
(503) 963-6494
(503) 963-6495
Mailing address
1827 NE 44TH AVE STE 390, PORTLAND, OR 97213-1461
(503) 963-6494
(503) 963-6495
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/13/2021
Last updated
09/13/2021
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