Healthcare Provider Details

I. General information

NPI: 1871213694
Provider Name (Legal Business Name): NANCY TOVAR QMHP-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 MAPLE CT
WHITE CITY OR
97503-1357
US

IV. Provider business mailing address

1221 DISK DR
MEDFORD OR
97501-6638
US

V. Phone/Fax

Practice location:
  • Phone: 541-830-1350
  • Fax: 541-830-6566
Mailing address:
  • Phone: 541-773-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL18147
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: