MEDICARE: MRS. TIFFANY LAREE LOWE MSW,QMHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1487677803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFANY LAREE LOWE MSW,QMHP

Provider Business Mailing Address
First Line	:	1627 NE 120TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-2015
Country	:	US
Telephone Number	:	503-997-0376
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 NE 102ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-4167
Country	:	US
Telephone Number	:	503-253-6754
Fax Number	:	503-253-8020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	09/11/2025

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