Provider Demographics
NPI:1497051916
Name:CARLSON, TANUJINI ROSALIND (MA)
Entity Type:Individual
Prefix:MISS
First Name:TANUJINI
Middle Name:ROSALIND
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TANUJINI
Other - Middle Name:ROSALIND
Other - Last Name:SENTHIRAJAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3415 SE POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3371
Mailing Address - Country:US
Mailing Address - Phone:503-813-7733
Mailing Address - Fax:503-205-0188
Practice Address - Street 1:3415 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3371
Practice Address - Country:US
Practice Address - Phone:503-813-7733
Practice Address - Fax:503-205-0188
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500676797Medicaid