MEDICARE: DANIELLE ASHLY MCWILLIAMS LPC

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
1	101YM0800X	Mental Health Counselor	4219	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22685842	OTHER		BUSINESS TAX ID NUMBER

General Provider Information

NPI Number	:	1477212975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE ASHLY MCWILLIAMS LPC

Provider Business Mailing Address
First Line	:	7523 SE HOLGATE BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-3359
Country	:	US
Telephone Number	:	503-544-7631
Fax Number	:

Provider Business Practice Location Address
First Line	:	1524 NW 23RD AVE STE D
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2686
Country	:	US
Telephone Number	:	503-544-7631
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2021
Last Update Date	:	12/12/2021

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