Provider Demographics
NPI:1417140518
Name:DAY, MAXINE SUZANNE (MA QMHP)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:SUZANNE
Last Name:DAY
Suffix:
Gender:F
Credentials:MA QMHP
Other - Prefix:
Other - First Name:MAXINE
Other - Middle Name:SUZANNE
Other - Last Name:TOLMIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:528 E MAIN
Mailing Address - Street 2:SUITE W
Mailing Address - City:JOHN DAY
Mailing Address - State:OR
Mailing Address - Zip Code:97845
Mailing Address - Country:US
Mailing Address - Phone:541-575-1466
Mailing Address - Fax:541-575-1411
Practice Address - Street 1:528 E MAIN
Practice Address - Street 2:SUITE W
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845
Practice Address - Country:US
Practice Address - Phone:541-575-1466
Practice Address - Fax:541-575-1411
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)