Individual
MYLES PETER OUELLETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC, CCS
Contact information
Practice address
200 CHAMPLAIN ST, VAN BUREN, ME 04785-1396
(207) 436-5195
Mailing address
PO BOX 415, VAN BUREN, ME 04785-0415
(207) 436-5195
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CCS7269
ME
225700000X
Massage Therapist
X#MT3349
ME
Other
Enumeration date
02/17/2010
Last updated
06/07/2023
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