Provider Demographics
NPI:1104642263
Name:CLIFTON, TYNE ZEWADSKI
Entity type:Individual
Prefix:
First Name:TYNE
Middle Name:ZEWADSKI
Last Name:CLIFTON
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SW TAYLOR ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-2446
Mailing Address - Country:US
Mailing Address - Phone:503-683-2083
Mailing Address - Fax:
Practice Address - Street 1:333 SW TAYLOR ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2446
Practice Address - Country:US
Practice Address - Phone:503-683-2083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR9989106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist