Provider Demographics
NPI:1154050987
Name:VALE, TIFFANY MARIE (QMHA CASE MANAGER)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:MARIE
Last Name:VALE
Suffix:
Gender:F
Credentials:QMHA CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N G ST
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97630-1417
Mailing Address - Country:US
Mailing Address - Phone:541-947-6021
Mailing Address - Fax:541-219-8114
Practice Address - Street 1:215 N G ST
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:OR
Practice Address - Zip Code:97630-1417
Practice Address - Country:US
Practice Address - Phone:541-947-6021
Practice Address - Fax:541-219-8114
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1O1YM0800X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator