Provider Demographics
NPI:1023454097
Name:THOMPSON, TIANA PETIT (LPC, LMHC)
Entity type:Individual
Prefix:MRS
First Name:TIANA
Middle Name:PETIT
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 NE 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1140
Mailing Address - Country:US
Mailing Address - Phone:971-998-6080
Mailing Address - Fax:
Practice Address - Street 1:2306 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2392
Practice Address - Country:US
Practice Address - Phone:971-998-6080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60586515101YM0800X
ORC4006103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health