Provider Demographics
NPI:1104218122
Name:MCCUISTION, MILTON TAULBEE (QMHA)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:TAULBEE
Last Name:MCCUISTION
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 SW RAMSEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5500
Mailing Address - Country:US
Mailing Address - Phone:541-956-4943
Mailing Address - Fax:541-956-3085
Practice Address - Street 1:1175 E MAIN ST STE 1C
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7457
Practice Address - Country:US
Practice Address - Phone:541-772-0127
Practice Address - Fax:541-772-0966
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OR101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator