Basic Information
| Provider Information | |||||||||
| NPI: | 1821331943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEIGHBORS | ||||||||
| FirstName: | DALLAS | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | CADC II, QMHA-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2045 SILVERTON RD NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973010100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035885351 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2045 SILVERTON RD NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973010100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035885351 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2013 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | 20-QMHA-R-0491 | OR | N | Other Service Providers | Case Manager/Care Coordinator | 101YA0400X | 11-06-54 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.