Individual provider Active NPI

Tanya Anne Prather, PHD

  • Clinical Psychologist
  • Portland, OR
National Provider Identifier
1952486409
Registry record updated Nov 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2246 Issued in OR
Practice address
2732 NE Broadway St
Portland, OR 97232-1723
Phone
(971) 212-5927
Fax
(971) 275-1008
NPI assigned
Oct 25, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 9, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY3359 WA
Clinical Psychologist 103TC0700X 2246 OR Primary

Addresses

Primary practice location

2732 NE Broadway St
Portland, OR 97232-1723

Mailing address

2732 NE Broadway St
Portland, OR 97232-1723
Phone (971) 212-5927

Other identifiers 2

IdentifierTypeStateIssuer
8999070OtherWAPERSONAL MEDICARE
164936MedicaidOR

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
I20130301000158 OR Practitioner - Clinical Psychologist 3375728199 Practice locations: Portland, OR

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2008 NE 79TH Ave
Suite 100
Portland, OR 97213-6658
Phone (971) 212-5927

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2246ORMDClinical Psychologist
PY3359WAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Western Psychological and Counseling Services LLC Clinical PastSince Dec 27, 2024 Accepting new patients
Western Psychological and Counseling Services LLC Clinical Past Accepting new patients

Organizations & group practices 2

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": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352419200000",
    "number": "1952486409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2732 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321723",
            "telephone_number": "971-212-5927",
            "fax_number": "971-275-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2732 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321723",
            "telephone_number": "971-212-5927",
            "fax_number": "971-275-1008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRATHER",
        "first_name": "TANYA",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2012-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY3359",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "2246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL MEDICARE",
            "identifier": "8999070",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164936",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.