Provider Demographics
NPI:1851677520
Name:TINGHITELLA, GLENN (MS)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:TINGHITELLA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12535 SW PATHFINDER CT
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5155
Mailing Address - Country:US
Mailing Address - Phone:503-819-2139
Mailing Address - Fax:
Practice Address - Street 1:163 NE GRANT ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-3024
Practice Address - Country:US
Practice Address - Phone:503-765-6362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WALH60676192101YP2500X
ORC3593101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health