Provider Demographics
NPI:1386341360
Name:MILLER, TONIA LEE (CRM/QMHA-R)
Entity type:Individual
Prefix:MS
First Name:TONIA
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CRM/QMHA-R
Other - Prefix:MS
Other - First Name:TONIA
Other - Middle Name:LEE
Other - Last Name:OSTVIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2045 SILVERTON RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-0100
Mailing Address - Country:US
Mailing Address - Phone:503-576-4589
Mailing Address - Fax:
Practice Address - Street 1:2045 SILVERTON RD NE STE A
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0100
Practice Address - Country:US
Practice Address - Phone:503-576-4589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1386341360175T00000X
OR23-QMHA-R-3525171M00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health