Provider Demographics
NPI:1487028361
Name:LAMOREAUX, TALLON (NP, PMHNP)
Entity Type:Individual
Prefix:
First Name:TALLON
Middle Name:
Last Name:LAMOREAUX
Suffix:
Gender:M
Credentials:NP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 NW 11TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2980
Mailing Address - Country:US
Mailing Address - Phone:033-791-9025
Mailing Address - Fax:
Practice Address - Street 1:308 NW 11TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2980
Practice Address - Country:US
Practice Address - Phone:503-379-1902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202009010NP-PP363LP0808X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor