Provider Demographics
NPI:1013410455
Name:VAN VLIET, TARYN WESLIE
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:WESLIE
Last Name:VAN VLIET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FORWARD STRIDE
Mailing Address - Street 2:23839 SW DANIEL RD.
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007
Mailing Address - Country:US
Mailing Address - Phone:503-217-2189
Mailing Address - Fax:503-217-2257
Practice Address - Street 1:FORWARD STRIDE
Practice Address - Street 2:23839 SW DANIEL RD.
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007
Practice Address - Country:US
Practice Address - Phone:503-217-2189
Practice Address - Fax:503-217-2257
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty