Provider Demographics
NPI:1346882578
Name:NUNEZ, MIREYA ELISSA I (QMHA)
Entity Type:Individual
Prefix:
First Name:MIREYA
Middle Name:ELISSA
Last Name:NUNEZ
Suffix:I
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-3115
Mailing Address - Country:US
Mailing Address - Phone:541-285-4393
Mailing Address - Fax:
Practice Address - Street 1:12665 SW CENTER STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005
Practice Address - Country:US
Practice Address - Phone:503-828-3402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor