Provider Demographics
NPI:1003564576
Name:MAHAFFIE, TORIANA
Entity Type:Individual
Prefix:
First Name:TORIANA
Middle Name:
Last Name:MAHAFFIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37875 JASPER LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:OR
Mailing Address - Zip Code:97438-9751
Mailing Address - Country:US
Mailing Address - Phone:541-747-1235
Mailing Address - Fax:
Practice Address - Street 1:37875 JASPER LOWELL RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:OR
Practice Address - Zip Code:97438-9751
Practice Address - Country:US
Practice Address - Phone:541-747-1235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR101YM0800XMedicaid