Basic Information
| Provider Information | |||||||||
| NPI: | 1225470156 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HWANG | ||||||||
| FirstName: | WILLIAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2016 NE HIGHLAND ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972115323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406413178 | ||||||||
| FaxNumber: | 3036172397 | ||||||||
| Practice Location | |||||||||
| Address1: | 4224 NE HALSEY ST STE 335 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972131568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039226616 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2013 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103T00000X | 3076 | OR | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.