Tilson, Mark David

Tilson, Mark David is an sole proprietor health care provider with primary practice located at 1015 Nw 22Nd Ave Rio - 5 East, Portland OR 97210-3025. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Neuropsychologist, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Rehabilitation. Behavioral Health & Social Service Providers / Clinical Neuropsychologist is his primary health care specialty. Tilson, Mark David can be contacted via phone (503) 413-7662.

Contact Information

Primary practice address
1015 Nw 22Nd Ave Rio - 5 East Portland OR 97210-3025
Phone: (503) 413-7662
Fax: (503) 413-8103
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X 826 Oregon
Behavioral Health & Social Service Providers / Clinical 103TC0700X 826 Oregon
Behavioral Health & Social Service Providers / Rehabilitation 103TR0400X 826 Oregon

Profile Details

NPI number 1134345523
LBN Legal business name Tilson, Mark David
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 17th, 2007
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134345523 NPPES
Oregon MEDICAID 079009

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