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General NPI Number Information
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NPI Number | 1538812458
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Entity Type | Organization
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Legal Business Name | TAYAS YAWKS
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 3206 ONYX AVE
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City | KLAMATH FALLS
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State | OR
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Zip | 97603-7279
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Country | US
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Telephone | 541-891-0194
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Fax |
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Provider Business Mailing Address
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Address Line | 3206 ONYX AVE
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City | KLAMATH FALLS
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State | OR
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Zip | 97603-7279
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Country | US
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Telephone | 541-891-0194
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Fax |
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Authorized Official
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Title or Position | CO-DIRECTOR
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Name | TAMMY MAE ANDERSON
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Credential | PSS
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Telephone | 541-891-0194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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