Provider Demographics
NPI:1619193315
Name:CUELLAR, MARIA L (CADCII)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 WINESAP AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2148
Mailing Address - Country:US
Mailing Address - Phone:208-452-3549
Mailing Address - Fax:
Practice Address - Street 1:885 SW 30TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-4626
Practice Address - Country:US
Practice Address - Phone:541-823-0101
Practice Address - Fax:541-823-0909
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR99-P-07101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)