Provider Demographics
NPI:1285005256
Name:SMITH, TIA PATRICIA (BS QHMA)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:PATRICIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:BS QHMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1967
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0978
Mailing Address - Country:US
Mailing Address - Phone:541-377-0747
Mailing Address - Fax:
Practice Address - Street 1:1809 SW ATHENS AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-4011
Practice Address - Country:US
Practice Address - Phone:541-377-0747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator