Healthcare Provider Details

I. General information

NPI: 1063817864
Provider Name (Legal Business Name): TAWNYA R MILLER TYPE 1 PROVIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAWNYA RENEE WRIGHT

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 W. 4TH AVE. SHELTERCARE
EUGENE OR
97401
US

IV. Provider business mailing address

506 W CENTENNIAL BLVD #44
SPRINGFIELD OR
97477
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-1262
  • Fax:
Mailing address:
  • Phone: 541-743-1869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: