Provider Demographics
NPI:1902243223
Name:PONTI-FOSS, PATRICIA
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:PONTI-FOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PK
Other - Middle Name:
Other - Last Name:FOSS-SAMAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LMFT
Mailing Address - Street 1:7831 SE STARK ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-2357
Mailing Address - Country:US
Mailing Address - Phone:503-804-5761
Mailing Address - Fax:
Practice Address - Street 1:7831 SE STARK ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-2357
Practice Address - Country:US
Practice Address - Phone:503-804-5761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1214101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health