MEDICARE: MR. ANDREW TODD MCWILLIAMS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1952451841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW TODD MCWILLIAMS

Provider Business Mailing Address
First Line	:	4535 SE BOISE ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-4037
Country	:	US
Telephone Number	:	503-788-4477
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 NE IRVING ST
Second Line	:	250
City	:	PORTLAND
State	:	OR
Zip	:	97232-2243
Country	:	US
Telephone Number	:	503-233-4356
Fax Number	:

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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