Provider Demographics
NPI:1477621464
Name:FITZ, MICHELLE ANNE (MED)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANNE
Last Name:FITZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 SE 121ST AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-4066
Mailing Address - Country:US
Mailing Address - Phone:503-335-5975
Mailing Address - Fax:503-335-5974
Practice Address - Street 1:2410 SE 121ST AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-4066
Practice Address - Country:US
Practice Address - Phone:503-335-5975
Practice Address - Fax:503-335-5974
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist