Provider Demographics
NPI:1922173947
Name:HADLEY, TINA (LMFT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:HADLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 SW 11TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2634
Mailing Address - Country:US
Mailing Address - Phone:503-944-1226
Mailing Address - Fax:503-224-6047
Practice Address - Street 1:521 SW 11TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2634
Practice Address - Country:US
Practice Address - Phone:503-944-1226
Practice Address - Fax:503-224-6047
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0671106H00000X
101YM0800X
OR08-06-28101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)