Individual
ADAM LYLE WILBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
58646 MCNULTY WAY, SAINT HELENS, OR 97051-6210
(503) 366-5211
Mailing address
58646 MCNULTY WAY, SAINT HELENS, OR 97051-6210
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123456
—
OR
01
—
13579
CRM
OR
Enumeration date
12/20/2022
Last updated
12/20/2022
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