Wyatt Fernelius, QMHA
Counselor in Portland, OR. Individual provider (NPI-1).
NPI number1982127874
StatusActive
Last updated in NPPESJul 21, 2017
Details
- NPI
- 1982127874
- Entity type
- Individual (NPI-1)
- Name
- Wyatt Fernelius
- Credential
- QMHA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 21, 2017
- Last updated
- Jul 21, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101Y00000X | Counselor | – | – | Yes |
Practice location
2640 Nw Alexandra AvePortland, OR 97210-1289
Phone 503-731-3978 · Fax 503-239-1252
Mailing address
Po Box 10027Portland, OR 97296-0027
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