Provider Demographics
NPI:1063817864
Name:MILLER, TAWNYA R (TYPE 1 PROVIDER)
Entity Type:Individual
Prefix:
First Name:TAWNYA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:TYPE 1 PROVIDER
Other - Prefix:
Other - First Name:TAWNYA
Other - Middle Name:RENEE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:506 W CENTENNIAL BLVD #44
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477
Mailing Address - Country:US
Mailing Address - Phone:541-743-1869
Mailing Address - Fax:
Practice Address - Street 1:499 W. 4TH AVE.
Practice Address - Street 2:SHELTERCARE
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-686-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health