| Tanya Fountain Llc | |
|
780 Commercial St Se Ste 201 Salem OR 97301-3463 | |
| (971) 599-3881 | |
| (503) 300-2848 |
| Full Name | Tanya Fountain Llc |
|---|---|
| Speciality | Social Worker |
| Location | 780 Commercial St Se Ste 201, Salem, Oregon |
| Authorized Official Name and Position | Tanya Fountain (CLINICAL SOCIAL WORKER/ THERAPIST) |
| Authorized Official Contact | 9715993881 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tanya Fountain Llc 780 Commercial St Se Ste 201 Salem OR 97301-3463 Ph: (971) 599-3881 | Tanya Fountain Llc 780 Commercial St Se Ste 201 Salem OR 97301-3463 Ph: (971) 599-3881 |
| NPI Number | 1942025598 |
|---|---|
| Provider Enumeration Date | 11/19/2024 |
| Last Update Date | 11/19/2024 |
| Certification Date | 11/19/2024 |
| Medicare PECOS PAC ID | 6305374547 |
|---|---|
| Medicare Enrollment ID | O20250115002306 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942025598 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tanya Rose Fountain |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235338559 PECOS PAC ID: 7810434768 Enrollment ID: I20240808004274 |
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