Provider Demographics
NPI:1346800976
Name:VILES, BRADLEY CHARLES (CRM/ CADC1-R/ QMHA-R)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:CHARLES
Last Name:VILES
Suffix:
Gender:M
Credentials:CRM/ CADC1-R/ QMHA-R
Other - Prefix:
Other - First Name:BRADLEY
Other - Middle Name:CHARLES
Other - Last Name:BALCUNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRM/ CADC-R/ QMHA-R
Mailing Address - Street 1:PO BOX 1234
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-8234
Mailing Address - Country:US
Mailing Address - Phone:503-432-9259
Mailing Address - Fax:
Practice Address - Street 1:58646 MCNULTY WAY
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-6210
Practice Address - Country:US
Practice Address - Phone:503-397-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18-CRM-366175T00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR18-CRM-366OtherCRM CERTIFICATION