Provider Demographics
NPI:1497407167
Name:WINBORNE, BELANNA MERCEDES
Entity Type:Individual
Prefix:MS
First Name:BELANNA
Middle Name:MERCEDES
Last Name:WINBORNE
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 1:15290 SW ROYALTY PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-4059
Mailing Address - Country:US
Mailing Address - Phone:971-368-8626
Mailing Address - Fax:
Practice Address - Street 1:15290 SW ROYALTY PKWY STE 300
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-4059
Practice Address - Country:US
Practice Address - Phone:971-256-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-IN-010215904106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician