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NPI Code Detail

MEDICARE: DANIEL MCNICHOLAS

MEDICARE: DANIEL MCNICHOLAS
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
1101YM0800XMental Health CounselorOR

General Provider Information

NPI Number : 1326460130
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL MCNICHOLAS
Provider Business Mailing Address
First Line : 1507 NE 122ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97230-1911
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1507 NE 122ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97230-1911
Country : US
Telephone Number : 503-258-4599
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2014
Last Update Date : 01/29/2022

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1609270461 — MS. EILEEN FRANCES AGUON MARTINEZ
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Directions to “ DANIEL MCNICHOLAS ” Practice Location

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