Provider Demographics
NPI:1730735028
Name:MINER, MANDY LYNN (QMHA-II, CADC-I, THW)
Entity type:Individual
Prefix:MS
First Name:MANDY
Middle Name:LYNN
Last Name:MINER
Suffix:
Gender:F
Credentials:QMHA-II, CADC-I, THW
Other - Prefix:MS
Other - First Name:MANDY
Other - Middle Name:LYNN
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHA-II, CADC-I, THW
Mailing Address - Street 1:330 S GARDEN WAY STE 350
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8179
Mailing Address - Country:US
Mailing Address - Phone:541-463-7462
Mailing Address - Fax:
Practice Address - Street 1:330 S GARDEN WAY STE 350
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8179
Practice Address - Country:US
Practice Address - Phone:541-763-7462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-06-11159101YA0400X
OR24-QMHA-II-000264101YM0800X
OK316485171M00000X
OR24CRM3244175T00000X
AZ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist