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NPI Code Detail

MEDICARE: RONALD K QUALLEY LAC

MEDICARE: RONALD K QUALLEY LAC
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) Counselor1326ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174609671
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD K QUALLEY LAC
Provider Business Mailing Address
First Line : PO BOX 1266
Second Line :
City : WILLISTON
State : ND
Zip : 58802-1266
Country : US
Telephone Number : 701-774-4600
Fax Number : 701-774-4620
Provider Business Practice Location Address
First Line : 316 2ND AVE W
Second Line :
City : WILLISTON
State : ND
Zip : 58801-5218
Country : US
Telephone Number : 701-774-4600
Fax Number : 701-774-4620
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 07/08/2007

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Directions to “ RONALD K QUALLEY LAC” Practice Location

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