Provider Demographics
NPI:1952486409
Name:PRATHER, TANYA ANNE (PHD)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:ANNE
Last Name:PRATHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1723
Mailing Address - Country:US
Mailing Address - Phone:971-212-5927
Mailing Address - Fax:971-275-1008
Practice Address - Street 1:2732 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1723
Practice Address - Country:US
Practice Address - Phone:971-212-5927
Practice Address - Fax:971-275-1008
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY3359103TC0700X
OR2246103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8999070OtherPERSONAL MEDICARE
OR164936Medicaid
OR0000WDBCHMedicare ID - Type Unspecified