MEDICARE: TONIA MARIE CASTILLEJA MS, QMHP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	08-03-04	OR
2	101YM0800X	Mental Health Counselor	R8536	OR
3	101YP2500X	Professional Counselor	R8536	OR

General Provider Information

NPI Number	:	1396182713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONIA MARIE CASTILLEJA MS, QMHP

Provider Business Mailing Address
First Line	:	3886 BEVERLY AVE NE STE 6
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1373
Country	:	US
Telephone Number	:	541-342-5088
Fax Number	:

Provider Business Practice Location Address
First Line	:	3886 BEVERLY AVE NE STE 6
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1373
Country	:	US
Telephone Number	:	541-342-5088
Fax Number	:

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

Provider Enumeration Date	:	05/24/2013
Last Update Date	:	06/05/2024

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