Doctor Name: | MS. TARA MAHONEY |
NPI Number: | 1073987046 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CADC II |
License Number: | 00-11-47 |
Business Practice Address: | 920 Sw Frazer Ave Pendleton, OR - 978012800 |
Business Phone Number: | 5412761022 |
Business Fax Number: | 5412151021 |
Mailing Address: | 920 Sw Frazer Ave # 219, PENDLETON |
State: | OR |
Postal Code: | 978012800 |
Phone Number: | 5412761022 |
Fax Number: | 5412151021 |
NPI Enumeration Date: | 11/13/2015 |
NPI Last Update Date: | 11/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 00-11-47 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |