Individual provider Active NPI

Tiffany Bro

  • Marriage & Family Therapist
  • Portland, OR
National Provider Identifier
1316635865
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
R9825 Issued in OR
Practice address
422 SE 79TH Ave # 204
Portland, OR 97215-1519
Phone
(503) 660-3480
NPI assigned
Apr 24, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X R9825 OR Primary
Case Manager/Care Coordinator 171M00000X

Addresses

Primary practice location

422 SE 79TH Ave # 204
Portland, OR 97215-1519

Mailing address

150 Beavercreek Rd
Oregon City, OR 97045-4302
Phone (503) 655-8471

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
R9825ORMDMarriage & Family Therapist

NPI Registry JSON

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

{
    "created_epoch": "1682294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1316635865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 BEAVERCREEK RD",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970454302",
            "telephone_number": "503-655-8471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 SE 79TH AVE # 204",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972151519",
            "telephone_number": "503-660-3480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRO",
        "first_name": "TIFFANY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-24",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "OR",
            "license": "R9825",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.