Provider Demographics
NPI:1811718653
Name:BANDA CORRALEJO, RAM ABRAM (QMHP-R)
Entity type:Individual
Prefix:
First Name:RAM
Middle Name:ABRAM
Last Name:BANDA CORRALEJO
Suffix:
Gender:M
Credentials:QMHP-R
Other - Prefix:
Other - First Name:RAM
Other - Middle Name:ABRAM
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:58646 MCNULTY WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-6210
Mailing Address - Country:US
Mailing Address - Phone:503-397-5211
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:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health