Provider Demographics
NPI:1114161106
Name:QUAST, OLEY (MA, LPC, CADC II)
Entity type:Individual
Prefix:
First Name:OLEY
Middle Name:
Last Name:QUAST
Suffix:
Gender:M
Credentials:MA, LPC, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 NE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4603
Mailing Address - Country:US
Mailing Address - Phone:503-222-2222
Mailing Address - Fax:
Practice Address - Street 1:420 NE 5TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4603
Practice Address - Country:US
Practice Address - Phone:503-224-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12-09-68101YA0400X
ORC7417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1114161106Medicaid