Provider Demographics
NPI:1154042166
Name:LI, SUSAN TINSLEY (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:TINSLEY
Last Name:LI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3060 SW CHRISTY AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1548
Mailing Address - Country:US
Mailing Address - Phone:503-530-9330
Mailing Address - Fax:
Practice Address - Street 1:1220 SW MORRISON ST STE 929
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2228
Practice Address - Country:US
Practice Address - Phone:503-530-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2105103TM1800X, 103TH0100X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service