Individual
MS. TARA ANNETTE BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
355 NW DIVISION ST, GRESHAM, OR 97030-5523
(503) 231-2641
(503) 231-1654
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C4119
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2075920
—
WA
05
—
500707358
—
OR
Enumeration date
03/24/2009
Last updated
09/24/2024
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