Provider Demographics
NPI:1861567802
Name:URWYLER, CHARLES JACOB (MSW, QMHP)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JACOB
Last Name:URWYLER
Suffix:
Gender:M
Credentials:MSW, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5037 SW CAMERON RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-1747
Mailing Address - Country:US
Mailing Address - Phone:503-244-1837
Mailing Address - Fax:
Practice Address - Street 1:2600 CENTER ST NE
Practice Address - Street 2:UNIT 35B
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2669
Practice Address - Country:US
Practice Address - Phone:503-945-7175
Practice Address - Fax:503-373-0900
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health