Healthcare Provider Details

I. General information

NPI: 1922126754
Provider Name (Legal Business Name): RAYMOND W HUGHEY M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 SW ACADEMY ST STE 304
DALLAS OR
97338-1900
US

IV. Provider business mailing address

33055 SE PEORIA RD
CORVALLIS OR
97333-2529
US

V. Phone/Fax

Practice location:
  • Phone: 503-623-9289
  • Fax:
Mailing address:
  • Phone: 541-738-6714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADC III 94-10-41
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: