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NPI Code Detail

MEDICARE: WILLIAM DELRAY TOLAND AAS CADCII,QMHA

MEDICARE: WILLIAM DELRAY TOLAND AAS CADCII,QMHA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor06-03-46OR
2171M00000XCase Manager/Care CoordinatorOR

General Provider Information

NPI Number : 1417093865
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM DELRAY TOLAND AAS CADCII,QMHA
Provider Business Mailing Address
First Line : PO BOX 1151
Second Line :
City : TURNER
State : OR
Zip : 97392-1151
Country : US
Telephone Number : 971-240-2253
Fax Number :
Provider Business Practice Location Address
First Line : 7525 SE LAKE RD
Second Line :
City : MILWAUKIE
State : OR
Zip : 97267-2115
Country : US
Telephone Number : 503-344-6075
Fax Number : 503-344-4112
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 01/10/2013

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