Tyrone Wayne Waters, PEER ADVOCATE LEAD

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

2034 SE 6TH Ave
Portland, OR 97214-4510

Phone

(503) 238-6801

NPI assigned

Jun 20, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Wellspring

  • Multi-Specialty Clinic/Center
  • Portland, OR
  • NPI 1912046202
  NPD (past)

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

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184284800000",
    "number": "1154526846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 N MORRIS ST",
            "address_2": "#315",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271572",
            "telephone_number": "503-238-6801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2034 SE 6TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144510",
            "telephone_number": "503-238-6801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "TYRONE",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "PEER ADVOCATE LEAD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-20",
        "last_updated": "2007-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ismond Waters
• Jennifer Waters
• Joan Lee Waters, GENERAL STUDIES AS
• Kirsten Karen Isakson Waters, RN, LAC
• Tracey Waters, PHARMD
• Watershed Community Wellness LLC
• Tiffany A Waterson
• Mary C. Wathen, ARNP, CNM
• Adam C Watkins
• Alicia Watkins

• Mental Health Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; 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.