Tara Holly Rayburn, CADCI is a
Psychologist - Addiction (substance Use Disorder) based in Portland, Oregon. Tara Holly Rayburn is licensed to practice in Oregon (license number 15-11-08) and her current practice location is
1722 Nw Raleigh St Spc 304, Portland, Oregon. She can be reached at her office (for appointments etc.) via phone at
(971) 645-0148.
NPI number for Tara Holly Rayburn is 1134584527 and her current mailing address is 1722 Nw Raleigh St Spc 304, Portland, Oregon. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1134584527.
Healthcare Provider's Profile
| Full Name | Tara Holly Rayburn |
|---|
| Gender | Female |
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| Speciality | Psychologist - Addiction (substance Use Disorder) |
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| Location | 1722 Nw Raleigh St Spc 304, Portland, Oregon |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1134584527
- Provider Enumeration Date: 12/29/2015
- Last Update Date: 08/31/2021
Medical Identifiers
Medical identifiers for Tara Holly Rayburn such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1134584527 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 20-10-06 (Oregon) | Secondary |
| 101YM0800X | Counselor - Mental Health | 21-QMHP-R-0664 (Oregon) | Secondary |
| 1041C0700X | Social Worker - Clinical | SWIA.SC.61162847 (Washington) | Secondary |
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | 15-11-08 (Oregon) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Tara Holly Rayburn is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Tara Holly Rayburn, CADCI
1722 Nw Raleigh St Spc 304,
Portland, OR 97209-1752
Ph: (503) 325-2067 | Tara Holly Rayburn, CADCI
1722 Nw Raleigh St Spc 304,
Portland, OR 97209-1752
Ph: (971) 645-0148 |
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