Provider Demographics
NPI:1689043572
Name:MUNOZ, EMILY A (BCJ, CRM, QMHA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:BCJ, CRM, QMHA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRM
Mailing Address - Street 1:254 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-3003
Mailing Address - Country:US
Mailing Address - Phone:503-737-4193
Mailing Address - Fax:
Practice Address - Street 1:254 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-3003
Practice Address - Country:US
Practice Address - Phone:503-737-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-CRM-154175T00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes175T00000XOther Service ProvidersPeer Specialist