Provider Demographics
NPI:1104198399
Name:MUSGROVE, DAVID NOLE (CADCII, NCACII, SAP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NOLE
Last Name:MUSGROVE
Suffix:
Gender:M
Credentials:CADCII, NCACII, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FIR ST STE 321
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2663
Mailing Address - Country:US
Mailing Address - Phone:541-963-4005
Mailing Address - Fax:541-663-8144
Practice Address - Street 1:105 FIR ST STE 321
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2663
Practice Address - Country:US
Practice Address - Phone:541-963-4005
Practice Address - Fax:541-663-8144
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor