Provider Demographics
NPI:1104989433
Name:HALLIMAN, LATOYA WYNETTE (QMHA)
Entity type:Individual
Prefix:MISS
First Name:LATOYA
Middle Name:WYNETTE
Last Name:HALLIMAN
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12942 SE MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-4151
Mailing Address - Country:US
Mailing Address - Phone:503-249-7767
Mailing Address - Fax:503-331-7595
Practice Address - Street 1:509 NE ALBERTA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3976
Practice Address - Country:US
Practice Address - Phone:503-249-7767
Practice Address - Fax:503-331-7595
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health