TATE ALLEN WAGGONER

PORTLAND, OR
NPI1356058978
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: OR  22-QMHP-R-1749)
Enumeration Date2022-11-02
Last Update Date2023-03-23
Business Address
Mr. TATE ALLEN WAGGONER QMHP-R
1310 SW 17TH AVE
PORTLAND, OR 97201-2522
Phone number: 503-231-2641
Mailing Address
Mr. TATE ALLEN WAGGONER QMHP-R
1776 SW MADISON ST
PORTLAND, OR 97205-1715
Phone number: 503-224-1044
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