Doctor Name: | MARITA TILLER |
NPI Number: | 1174846869 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA |
License Number: | |
Business Practice Address: | 880 82nd Dr Gladstone, OR - 970271803 |
Business Phone Number: | 5036595515 |
Business Fax Number: | |
Mailing Address: | Po Box 82819, PORTLAND |
State: | OR |
Postal Code: | 972820819 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/09/2010 |
NPI Last Update Date: | 03/09/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |