Provider Demographics
NPI:1275200586
Name:TINGLE, MAKAYLA LOUISE (BS, QMHC)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:LOUISE
Last Name:TINGLE
Suffix:
Gender:F
Credentials:BS, QMHC
Other - Prefix:
Other - First Name:MAKAYLA
Other - Middle Name:LOUISE
Other - Last Name:HOHENSHELT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, QMHC
Mailing Address - Street 1:805 LIBERTY ST NE STE 2
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2463
Mailing Address - Country:US
Mailing Address - Phone:503-589-3112
Mailing Address - Fax:503-589-3179
Practice Address - Street 1:805 LIBERTY ST NE STE 2
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2463
Practice Address - Country:US
Practice Address - Phone:503-589-3112
Practice Address - Fax:503-589-3179
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health