MEDICARE: MISS TEZZA LYDIA PHILLIPS LPC

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	R8915	OR

General Provider Information

NPI Number	:	1902309529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TEZZA LYDIA PHILLIPS LPC

Provider Business Mailing Address
First Line	:	6975 SW SANDBURG ST STE 250
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-8088
Country	:	US
Telephone Number	:	503-436-6997
Fax Number	:	503-447-5152

Provider Business Practice Location Address
First Line	:	6975 SW SANDBURG ST STE 250
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-8088
Country	:	US
Telephone Number	:	503-436-6997
Fax Number	:	503-447-5152

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

Provider Enumeration Date	:	03/09/2018
Last Update Date	:	06/01/2026

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