Provider Demographics
NPI:1396819785
Name:FISCUS, ELLEN J (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:J
Last Name:FISCUS
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1042
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-4042
Mailing Address - Country:US
Mailing Address - Phone:503-781-3887
Mailing Address - Fax:
Practice Address - Street 1:2032 COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1753
Practice Address - Country:US
Practice Address - Phone:503-781-3887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health