Individual
TESSA ROSE FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC-R
Contact information
Practice address
2318 NE MLK JR BLVD, PORTLAND, OR 97212-3715
(503) 802-0299
Mailing address
2318 NE MLK JR BLVD, PORTLAND, OR 97212-3715
(503) 802-0299
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-22-1681
OR
101YM0800X
Mental Health Counselor
22-QMHA-R-2556
OR
Other
Enumeration date
06/30/2022
Last updated
06/30/2022
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