Provider Demographics
NPI:1609020510
Name:MCCLEARY, TIFFANY LORRAINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:LORRAINE
Last Name:MCCLEARY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:LORRAINE
Other - Last Name:PARCEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2188 SW PARK PL
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1100
Mailing Address - Country:US
Mailing Address - Phone:503-701-6713
Mailing Address - Fax:503-232-0138
Practice Address - Street 1:2188 SW PARK PL
Practice Address - Street 2:SUITE 305
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1100
Practice Address - Country:US
Practice Address - Phone:503-701-6713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2042103TC0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health