Tigist Y Fantaye

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

4212 SE Division St Ste 100
Portland, OR 97206-1680

Phone

(503) 238-0705

NPI assigned

Mar 11, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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": "1583884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583884800000",
    "number": "1689209504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8459",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972078459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 SE DIVISION ST STE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972061680",
            "telephone_number": "503-238-0705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANTAYE",
        "first_name": "TIGIST",
        "middle_name": "Y",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-11",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "201906814RN",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sydney Hanna Fanning, PMHNP
• Fanno Creek Clinic LLC
• Erin Fanshier, MSW
• Edlawet G Fanta
• Hawi Fantaye, RN, BSN
• Far East Chiropractic
• Parker Reid Farabee, PT, DPT
• Michelle Tate Farago, D.C.
• Adam Farah
• Hadi Farah, M.D.

• All providers in Portland, OR
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; 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.