MEDICARE: TAMARA WERNER-FITZ GIBBON LPC, LMHC

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	LH60735577	WA
2	101YM0800X	Mental Health Counselor	C4497	OR

General Provider Information

NPI Number	:	1427456938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA WERNER-FITZ GIBBON LPC, LMHC

Provider Business Mailing Address
First Line	:	11 NE MLK BLVD STE 203
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-3579
Country	:	US
Telephone Number	:	971-350-1122
Fax Number	:	971-350-3401

Provider Business Practice Location Address
First Line	:	11 NE MLK BLVD STE 203
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-3579
Country	:	US
Telephone Number	:	971-350-1122
Fax Number	:	971-350-3401

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

Provider Enumeration Date	:	12/15/2014
Last Update Date	:	05/23/2025

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