Provider Demographics
NPI:1720886484
Name:MA, YIRAN
Entity type:Individual
Prefix:
First Name:YIRAN
Middle Name:
Last Name:MA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15110 SW MALLARD DR UNIT 204
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-9378
Mailing Address - Country:US
Mailing Address - Phone:541-606-9843
Mailing Address - Fax:855-750-2962
Practice Address - Street 1:5005 MEADOWS RD STE 405
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4291
Practice Address - Country:US
Practice Address - Phone:971-232-1120
Practice Address - Fax:855-750-2962
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health