Provider Demographics
NPI:1174105639
Name:HIROSHIMA, TARYN
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:HIROSHIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 SW BARNES RD APT H207
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-7714
Mailing Address - Country:US
Mailing Address - Phone:650-504-3990
Mailing Address - Fax:
Practice Address - Street 1:8150 SW BARNES RD APT H207
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-7714
Practice Address - Country:US
Practice Address - Phone:971-410-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-24
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty