Tate Allen Waggoner, QMHP-C

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

25-QMHP-C-001612 Issued in OR

Practice address

1631 SW Columbia St
Portland, OR 97201-6025

Phone

(503) 231-2641

Fax

(503) 467-4077

NPI assigned

Nov 2, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741219200000",
    "number": "1356058978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 SE CARUTHERS ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144502",
            "telephone_number": "503-224-1044",
            "fax_number": "971-260-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 SW COLUMBIA ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972016025",
            "telephone_number": "503-231-2641",
            "fax_number": "503-467-4077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "TATE",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "QMHP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-11-02",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "25-QMHP-C-001612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500814541",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen A Wager, D.C.
• Melissa J Wages, DDS
• Haley Waggoner
• Leann Waggoner, CSWA
• Samuel Russell Waggoner
• Jocelyn Moore Wagman
• Wagner Family Dentistry
• Susan Lyn Wagner-Debusman, RN
• Abigail Wagner
• Amy W Wagner, PH.D.

• Mental Health Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.