NPIMap

Individual provider Active NPI

Tabitha Becker

  • Clinical Child & Adolescent Psychologist
  • Lake Oswego, OR
National Provider Identifier
1023411485
Registry record updated Sep 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
2484 Issued in OR
Practice address
201 B Ave
Suite 285
Lake Oswego, OR 97034-3159
Phone
(503) 636-0508
Fax
(503) 636-0387
NPI assigned
Sep 30, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 2484 OR
Clinical Psychologist 103TC0700X 2484 OR
Clinical Child & Adolescent Psychologist 103TC2200X 2484 OR Primary
Health Psychologist 103TH0004X 2484 OR
Intellectual & Developmental Disabilities Psychologist 103TM1800X 2484 OR

Addresses

Primary practice location

201 B Ave
Suite 285
Lake Oswego, OR 97034-3159

Mailing address

201 B Ave
Suite 285
Lake Oswego, OR 97034-3159
Phone (503) 636-0508

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2484ORMDHealth Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
360 Pediatric Psychology, PC Clinical Neuropsychologist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1412035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412035200000",
    "number": "1023411485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 B AVE",
            "address_2": "SUITE 285",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970343159",
            "telephone_number": "503-636-0508",
            "fax_number": "503-636-0387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 B AVE",
            "address_2": "SUITE 285",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970343159",
            "telephone_number": "503-636-0508",
            "fax_number": "503-636-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BECKER",
        "first_name": "TABITHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-30",
        "last_updated": "2014-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "OR",
            "license": "2484",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "2484",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "OR",
            "license": "2484",
            "primary": true
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "OR",
            "license": "2484",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "OR",
            "license": "2484",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.