MEDICARE: TAMMY SMIETANA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	15-02-21	OR
3	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1831557032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY SMIETANA

Provider Business Mailing Address
First Line	:	3680 MIDWAY DR
Second Line	:
City	:	BAKER CITY
State	:	OR
Zip	:	97814-1466
Country	:	US
Telephone Number	:	541-523-4049
Fax Number	:

Provider Business Practice Location Address
First Line	:	3680 MIDWAY DR
Second Line	:
City	:	BAKER CITY
State	:	OR
Zip	:	97814-1466
Country	:	US
Telephone Number	:	541-523-4049
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	06/17/2019

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Directions to “ TAMMY SMIETANA ” Practice Location

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