Provider Demographics
NPI:1487677803
Name:LOWE, TIFFANY LAREE (MSW,QMHP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LAREE
Last Name:LOWE
Suffix:
Gender:F
Credentials:MSW,QMHP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:LAREE
Other - Last Name:THELIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1627 NE 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2015
Mailing Address - Country:US
Mailing Address - Phone:503-997-0376
Mailing Address - Fax:
Practice Address - Street 1:131 NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4167
Practice Address - Country:US
Practice Address - Phone:503-253-6754
Practice Address - Fax:503-253-8020
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical