Healthcare Provider Details

I. General information

NPI: 1659954022
Provider Name (Legal Business Name): GRETA RENEE SANCHEZ THW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETA RENEE WILLIS

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 WEBBER ST
THE DALLES OR
97058-3749
US

IV. Provider business mailing address

1060 WEBBER ST
THE DALLES OR
97058-3749
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-5452
  • Fax: 541-296-1537
Mailing address:
  • Phone: 541-296-5452
  • Fax: 541-296-1537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21-CRM-562
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: