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Tara Lee Fetterly, QMHA
Peer Specialist in Prineville, Oregon
NPI 1790222487

Tara Lee Fetterly is a Peer Specialist based in Prineville, OR. Tara Lee Fetterly practices in Prineville, OR and has the professional credentials of QMHA. The NPI Number for Tara Lee Fetterly is 1790222487 and holds a License No. (Oregon).

The current practice location address for Tara Lee Fetterly is 1251 Ne Elm St, Prineville, OR and can be reached out via phone at 541-323-5330 and via fax at 541-447-4418.

Location: 1251 Ne Elm St, Prineville, OR, 97754-1206
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1790222487
Provider Name
Tara Lee Fetterly
Credential
QMHA
Provider Entity Type
Individual
Gender
Female
Address
1251 Ne Elm St, Prineville, OR, 97754-1206
Phone Number
541-323-5330
Fax Number
541-447-4418
Provider Enumeration Date
01/19/2017
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
283234 05 OR
institution
Provider Business Practice Location Address Details
Address
1251 Ne Elm St
City
Prineville
State
Oregon
Zip
97754-1206
Phone Number
541-323-5330
Fax Number
541-447-4418
person
Provider Business Mailing Address Details
Address
1251 Ne Elm St
City
Prineville
State
Oregon
Zip
97754-1206
Phone Number
541-323-5330
Fax Number
541-447-4418
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
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Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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