Provider Demographics
NPI:1497060842
Name:SANDOVAL, BASILIO ARREOLA (COUNSELOR CADC-I)
Entity Type:Individual
Prefix:MR
First Name:BASILIO
Middle Name:ARREOLA
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:COUNSELOR CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 WEST 5TH AVE,
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402
Mailing Address - Country:US
Mailing Address - Phone:541-687-2667
Mailing Address - Fax:541-284-2139
Practice Address - Street 1:944 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5106
Practice Address - Country:US
Practice Address - Phone:541-687-2667
Practice Address - Fax:541-284-2139
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCOUNSELOR CADC-I171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator