Individual provider Active NPI

Tyree John Dingle

  • Clinical Psychologist
  • Portland, OR
National Provider Identifier
1710476684
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3940 Issued in OR
Practice address
1411 SW Morrison St Ste 310
Portland, OR 97205-1945
Phone
(503) 352-2400
NPI assigned
May 7, 2018
Last updated
Jan 7, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Clinical Psychologist 103TC0700X 3940 OR Primary

Addresses

Primary practice location

1411 SW Morrison St Ste 310
Portland, OR 97205-1945

Mailing address

101 E Broadway Ste 400
Eugene, OR 97401-3104
Phone (541) 357-9764

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250206002872 OR Practitioner - Clinical Psychologist 7618407594 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

940 Willamette St
Suite 230
Eugene, OR 97401-3129
Phone (541) 357-9761

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3940ORMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Behavioral Care of Colorado, P.C. Clinical Current Accepting new patients
Optum Behavioral Care of Colorado, P.C. CurrentSince Jan 3, 2025 Accepting new patients
Optum Behavioral Care of Colorado, P.C. Clinical CurrentSince Jan 3, 2025 Accepting new patients
Psychological Healthcare, PLLC Past Accepting new patients

Locations

101 E Broadway
Ste 400
Eugene, OR 97401
Phone (541) 357-9764

399 E 10th Ave
Eugene, OR 97401
Phone (541) 868-2004

940 Willamette St
Ste 230
Eugene, OR 97401
Phone (541) 354-9764

Interoperability endpoints

  • Direct secure messaging: tyree.dingle.1@28621.direct.athenahealth.com

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1525651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1710476684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E BROADWAY STE 400",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013104",
            "telephone_number": "541-357-9764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 SW MORRISON ST STE 310",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051945",
            "telephone_number": "503-352-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DINGLE",
        "first_name": "TYREE",
        "middle_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-07",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "3940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.