Provider Demographics
NPI:1477913911
Name:PRITT, TANYA MARIA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIA
Last Name:PRITT
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 1:518 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4439
Mailing Address - Country:US
Mailing Address - Phone:541-231-4315
Mailing Address - Fax:541-753-7805
Practice Address - Street 1:518 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4439
Practice Address - Country:US
Practice Address - Phone:541-231-4315
Practice Address - Fax:541-753-7805
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCADCII 02-07-85101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)