Healthcare Provider Details

I. General information

NPI: 1043839053
Provider Name (Legal Business Name): WILLIAM C WEISZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 MEDICAL PKWY
ENTERPRISE OR
97828-5140
US

IV. Provider business mailing address

307 RESIDENCE ST
ENTERPRISE OR
97828-1606
US

V. Phone/Fax

Practice location:
  • Phone: 541-426-4524
  • Fax:
Mailing address:
  • Phone: 208-816-9404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number26-QMHP-R-4476
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: