Provider Demographics
NPI:1437904174
Name:MAHNKE, WILLIAM GEOFFREY (QMHP-R)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GEOFFREY
Last Name:MAHNKE
Suffix:
Gender:M
Credentials:QMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 TIMOTHY DR
Mailing Address - Street 2:
Mailing Address - City:CULVER
Mailing Address - State:OR
Mailing Address - Zip Code:97734-7009
Mailing Address - Country:US
Mailing Address - Phone:541-604-0388
Mailing Address - Fax:
Practice Address - Street 1:259 TIMOTHY DR
Practice Address - Street 2:
Practice Address - City:CULVER
Practice Address - State:OR
Practice Address - Zip Code:97734-7009
Practice Address - Country:US
Practice Address - Phone:541-604-0388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health