Provider Demographics
NPI:1467762302
Name:BENSON, TYANNA (QMHP, LSWAIC, MSW)
Entity Type:Individual
Prefix:
First Name:TYANNA
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:QMHP, LSWAIC, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 SW YAMHILL ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-3316
Mailing Address - Country:US
Mailing Address - Phone:503-523-0296
Mailing Address - Fax:503-523-0296
Practice Address - Street 1:16100 NW CORNELL RD # 220
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7334
Practice Address - Country:US
Practice Address - Phone:503-878-8885
Practice Address - Fax:971-297-1360
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA613234701041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator