Individual
TARA HOLLY RAYBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADCI
Contact information
Practice address
1722 NW RALEIGH ST SPC 304, PORTLAND, OR 97209-1752
(971) 645-0148
Mailing address
1722 NW RALEIGH ST SPC 304, PORTLAND, OR 97209-1752
(503) 325-2067
(503) 325-2153
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
20-10-06
OR
101YM0800X
Mental Health Counselor
21-QMHP-R-0664
OR
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
15-11-08
OR
1041C0700X
Clinical Social Worker
SWIA.SC.61162847
WA
Other
Enumeration date
12/29/2015
Last updated
08/31/2021
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