Individual provider · Type 1 NPI

Tate Allen Waggoner, QMHP-C

Mental Health Counselor · Portland, OR

NPI number 1356058978 Active

Practice location

1631 SW Columbia St
Portland, OR 97201-6025

Call (503) 231-2641 Map

Fax (503) 467-4077

Mailing address

211 SE Caruthers St
Portland, OR 97214-4502

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800X25-QMHP-C-001612 (OR)

Mental Health Counselor: Definition to come...

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About NPI 1356058978

Tate Allen Waggoner, QMHP-C's National Provider Identifier is 1356058978, issued on Nov 2, 2022. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Portland, OR. The record was last updated on Mar 6, 2025.