Healthcare Provider Details

I. General information

NPI: 1902309529
Provider Name (Legal Business Name): TEZZA LYDIA PHILLIPS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6975 SW SANDBURG ST STE 250
TIGARD OR
97223-8088
US

IV. Provider business mailing address

6975 SW SANDBURG ST STE 250
TIGARD OR
97223-8088
US

V. Phone/Fax

Practice location:
  • Phone: 503-436-6997
  • Fax: 503-447-5152
Mailing address:
  • Phone: 503-436-6997
  • Fax: 503-447-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR8915
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: