MEDICARE: ELLEN J FISCUS MA, LPC, NCC

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

General Provider Information

NPI Number	:	1396819785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN J FISCUS MA, LPC, NCC

Provider Business Mailing Address
First Line	:	PO BOX 1042
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-4042
Country	:	US
Telephone Number	:	503-781-3887
Fax Number	:

Provider Business Practice Location Address
First Line	:	2032 COLLEGE WAY
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-1753
Country	:	US
Telephone Number	:	503-781-3887
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	05/06/2013

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