Tyler James Boulanger

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

Practice address

4212 SE Division St
Portland, OR 97206-1680

Phone

(503) 238-0705

Fax

(503) 236-7166

NPI assigned

Oct 29, 2020

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

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

{
    "created_epoch": "1603929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661040000000",
    "number": "1700486586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4212 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972061680",
            "telephone_number": "503-238-0705",
            "fax_number": "503-236-7166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972061680",
            "telephone_number": "503-238-0705",
            "fax_number": "503-236-7166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULANGER",
        "first_name": "TYLER",
        "middle_name": "JAMES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-29",
        "last_updated": "2022-08-21",
        "certification_date": "2022-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Kay Boucher, DO
• Ashley Nicole Boudet, N.D.
• Eilis Ann Boudreau, MD
• Elizabeth Jean Boudreau, PA-C
• Tina Han Bouillion, MS, CADC II, LPC
• Boulder Care Provider Group PA
• Conor Boulger
• Tyler Dallin Boulter, MD
• Ann Bouma
• Lucas Benjamin Boumann

• Counseling Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Counseling Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2022; 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.