Provider Demographics
NPI:1023411485
Name:BECKER, TABITHA
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:BECKER
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 1:201 B AVE
Mailing Address - Street 2:SUITE 285
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3159
Mailing Address - Country:US
Mailing Address - Phone:503-636-0508
Mailing Address - Fax:503-636-0387
Practice Address - Street 1:201 B AVE
Practice Address - Street 2:SUITE 285
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3159
Practice Address - Country:US
Practice Address - Phone:503-636-0508
Practice Address - Fax:503-636-0387
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2484103G00000X, 103TC0700X, 103TC2200X, 103TH0004X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities