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NPISignal

Individual Healthcare Provider

Tara Holly Rayburn, CADCI

NPI Record: ActivePsychologist — Addiction (Substance Use Disorder)
NPI1134584527
Portland, Oregon

Provider's NPPES record last updated: August 31, 2021

Overview

Entity Type
Individual Healthcare Provider
NPI
1134584527
Primary Specialty
Psychologist — Addiction (Substance Use Disorder)
Practice Location
Portland, Oregon
Sole Proprietor
Yes

Federal Screening

NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.

List of Excluded Individuals/Entities (LEIE)

HHS Office of Inspector General

No potential match identified

No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.

Source data
September 10, 2026
Records indexed
84,001
Screened
Sep 18, 2026, 4:17 AM UTC

This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.

SAM.gov Exclusions

U.S. General Services Administration

Not checked

SAM.gov Exclusions was not checked.

SAM.gov screening is not configured on this deployment. No SAM check has been performed.

Screened
Not checked

This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.

This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.

Run a name-based screening

Searches OIG LEIE and SAM.gov by name and reviews every potential match.

Specialties & Taxonomies

  • Psychologist

    Addiction (Substance Use Disorder)

    Behavioral Health & Social Service Providers

    Primary

    A psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psychoactive substances (e.g., nicotine, marijuana, cocaine, heroin) or behavioral addictions (e.g., gambling) with the aim of cessation or reduction of use and/or the amelioration of emotional, behavioral, interpersonal and other problems arising from the addictive behavior.

    Taxonomy code 103TA0400X
  • Counselor

    Addiction (Substance Use Disorder)

    Behavioral Health & Social Service Providers

    Definition to come...

    Taxonomy code 101YA0400X
  • Counselor

    Mental Health

    Behavioral Health & Social Service Providers

    Definition to come...

    Taxonomy code 101YM0800X
  • Social Worker

    Clinical

    Behavioral Health & Social Service Providers

    A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

    Taxonomy code 1041C0700X

Provider-Reported License Information

Psychologist (Oregon)
15-11-08
Counselor (Oregon)
20-10-06
Counselor (Oregon)
21-QMHP-R-0664
Social Worker (Washington)
SWIA.SC.61162847
License numbers are reported by the provider to NPPES and are not independently verified by NPISignal against any state licensing board. Confirm current license status directly with the issuing state board.

Practice Locations

Practice Location

1722 Nw Raleigh St Spc 304

Portland, Oregon 97209-1752

Phone: (971) 645-0148

Record Information

Enumeration Date
December 29, 2015
Provider's NPPES Record Last Updated
August 31, 2021
Certification Date
August 31, 2021
NPISignal NPPES Dataset
August 2026

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