Individual
TASHA ANNE WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC 1, CRM, PSS
Contact information
Practice address
155 S EMPIRE BLVD, COOS BAY, OR 97420-3374
(541) 756-3111
(541) 756-2111
Mailing address
1942 SHERIDAN AVE, NORTH BEND, OR 97459-3416
(541) 756-3111
(541) 756-2111
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12-12-62
OR
101YM0800X
Mental Health Counselor
19-QMHA-I-00761
OR
175T00000X
Peer Specialist
11-CRM-131
OR
175T00000X
Peer Specialist
THW000002674
OR
Other
Enumeration date
12/28/2018
Last updated
04/15/2019
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