Provider Demographics
NPI:1578707998
Name:BLESSING, TAMMIE R (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:R
Last Name:BLESSING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TAMMIE
Other - Middle Name:R
Other - Last Name:CLAUSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814
Mailing Address - Country:US
Mailing Address - Phone:541-519-6868
Mailing Address - Fax:541-523-4927
Practice Address - Street 1:3975 MIDWAY DRIVE
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814
Practice Address - Country:US
Practice Address - Phone:541-524-9070
Practice Address - Fax:541-524-9077
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
ORL5515104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR014274Medicaid
OR500666411Medicaid