Provider Demographics
NPI:1235649849
Name:TULLIS-ROBINSON, LIANNA HALLE
Entity Type:Individual
Prefix:
First Name:LIANNA
Middle Name:HALLE
Last Name:TULLIS-ROBINSON
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 1:0615 SW PALATINE HILL RD # MSC0123
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7879
Mailing Address - Country:US
Mailing Address - Phone:503-706-9724
Mailing Address - Fax:
Practice Address - Street 1:4445 SW BARBUR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4047
Practice Address - Country:US
Practice Address - Phone:503-768-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health