Provider Demographics
NPI:1689700916
Name:TANNER, MISTY (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:
Last Name:TANNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 SW SCHOLLS FERRY RD
Mailing Address - Street 2:APT A3
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6573
Mailing Address - Country:US
Mailing Address - Phone:503-641-8641
Mailing Address - Fax:
Practice Address - Street 1:3720 SW 141ST AVE
Practice Address - Street 2:#204
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2382
Practice Address - Country:US
Practice Address - Phone:503-942-1475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor