Provider Demographics
NPI:1003196742
Name:SALAS, TOMMIE MAE (MS/P, MA)
Entity Type:Individual
Prefix:MS
First Name:TOMMIE
Middle Name:MAE
Last Name:SALAS
Suffix:
Gender:F
Credentials:MS/P, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 37TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-5304
Mailing Address - Country:US
Mailing Address - Phone:503-983-0489
Mailing Address - Fax:503-585-0491
Practice Address - Street 1:275 37TH AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-5304
Practice Address - Country:US
Practice Address - Phone:503-983-0489
Practice Address - Fax:503-585-0491
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health