Tia M Cook

Individual provider Active NPI Mental Health Counselor · Boardman, OR

NPI 1972017887 · NPPES record last updated Mar 16, 2020

Key facts

NPI
1972017887
Entity type
Individual (NPI type 1)
Primary specialty
Mental Health Counselor 101YM0800X
Practice address
70362 Kunze LN
Boardman, OR 97818-8013
Phone
(541) 481-3233
Fax
(541) 481-3234
NPI assigned
Nov 30, 2017
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Community Counseling Solutions Mental Health Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Yes

Addresses

Primary practice location

70362 Kunze LN
Boardman, OR 97818-8013

Mailing address

3587 Heathrow Way
Medford, OR 97504-4004
Phone (541) 858-8170

Other providers in Boardman, OR

All providers in Boardman, OR · Mental Health Counselor in Oregon

Sources for this page

Verify at the official NPI Registry.