Provider Demographics
NPI:1629341946
Name:AMOROK, TINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:AMOROK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2446
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-2446
Mailing Address - Country:US
Mailing Address - Phone:541-971-3452
Mailing Address - Fax:541-636-2455
Practice Address - Street 1:636 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4442
Practice Address - Country:US
Practice Address - Phone:541-971-3452
Practice Address - Fax:541-636-2455
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2088103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical