Provider Demographics
NPI:1093233355
Name:CANNING, TINA RENE'
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:RENE'
Last Name:CANNING
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 1:3842 NE LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6801
Mailing Address - Country:US
Mailing Address - Phone:503-367-6134
Mailing Address - Fax:
Practice Address - Street 1:510 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4402
Practice Address - Country:US
Practice Address - Phone:503-501-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health