Provider Demographics
NPI:1871213694
Name:TOVAR, NANCY (QMHP-R)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:TOVAR
Suffix:
Gender:F
Credentials:QMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7667
Mailing Address - Country:US
Mailing Address - Phone:541-773-3863
Mailing Address - Fax:541-500-8171
Practice Address - Street 1:2830 MAPLE CT
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-1357
Practice Address - Country:US
Practice Address - Phone:541-830-1350
Practice Address - Fax:541-830-6566
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-QMHP-R-1513101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health