Provider Demographics
NPI:1497125728
Name:TIRADO, STEPHEN GAIL FAYE
Entity Type:Individual
Prefix:MS
First Name:STEPHEN GAIL
Middle Name:FAYE
Last Name:TIRADO
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 1:937 SW 11TH ST
Mailing Address - Street 2:APT 1
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-3048
Mailing Address - Country:US
Mailing Address - Phone:541-350-6929
Mailing Address - Fax:541-504-7017
Practice Address - Street 1:1655 SW HIGHLAND AVE
Practice Address - Street 2:#3
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2558
Practice Address - Country:US
Practice Address - Phone:541-923-2654
Practice Address - Fax:541-504-7017
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health