Provider Demographics
NPI:1659022978
Name:CARNAHAN, WILLIAM ROY (QMHA-R)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROY
Last Name:CARNAHAN
Suffix:
Gender:M
Credentials:QMHA-R
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:ROY
Other - Last Name:CARNAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:QMHA-R
Mailing Address - Street 1:1776 SW MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1715
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:503-621-2235
Practice Address - Street 1:12360 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1042
Practice Address - Country:US
Practice Address - Phone:971-279-4800
Practice Address - Fax:971-279-2051
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-QMHA-R-2843101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health