Provider Demographics
NPI:1700369113
Name:VALDEZ-SNOOK, TANYA LOUISE (CRM)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LOUISE
Last Name:VALDEZ-SNOOK
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8425
Mailing Address - Country:US
Mailing Address - Phone:415-772-2763
Mailing Address - Fax:415-734-3164
Practice Address - Street 1:777 MURPHY RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8425
Practice Address - Country:US
Practice Address - Phone:415-772-2763
Practice Address - Fax:415-734-3164
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19-CRM-008175T00000X
ORT-19-149101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist