Provider Demographics
NPI:1164655619
Name:WOOD, BRIAN EUGENE (QMHA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:EUGENE
Last Name:WOOD
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 1:780 COMMERCIAL ST SE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3462
Mailing Address - Country:US
Mailing Address - Phone:503-365-0045
Mailing Address - Fax:503-365-9590
Practice Address - Street 1:780 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 104
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3462
Practice Address - Country:US
Practice Address - Phone:503-365-0045
Practice Address - Fax:503-365-9590
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator