Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor |
NPI | 1003196742 |
---|---|
Provider Name | Ms. Tommie Mae Salas |
First Address | Salem, OR 97317-5304 |
Second Address | Salem, OR 97317-5304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2011 |
Last Update Date | 29/02/2016 |