MR. MACK WILLIAM TOLLE (NPI# 1477073377) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477073377 |
| Entity Type | Individual |
| Full Name | MR. MACK WILLIAM TOLLE |
| Credential | CAADE |
| Practice Address |
321 E Carnegie Dr 210 San Bernardino CA 92415-3012 |
| Mailing Address |
508 S 2nd Ave Covina CA 91723-3012 |
| Practice Telephone | 9094214601 |
| Practice Fax Number | 9093812172 |
| Mailing Telephone | 6269748123 |
| Mailing Fax Number | 6269748198 |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2020-01-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
1913097 | CA | Behavioral Health & Social Service Providers |
| Street Address |
321 E CARNEGIE DR 210 |
| City | SAN BERNARDINO |
| State | CA |
| Zip Code | 92415-3012 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578041042 | Karina Judith Barragan | Student in an Organized Health Care Education/Training Program | 19500 South Sunwest Lane, San Bernardino, CA 92415 | 2018-08-06 |
| 1841714839 | Layla Subhani | Marriage & Family Therapist | 780 E Gilbert Street, Bldg H, San Bernardino, CA 92415 | 2017-08-01 |
| 1023546637 | Angelica Ruiz | Marriage & Family Therapist | 900 E. Gilbert Street, Cottage 4, San Bernardino, CA 92415 | 2017-05-25 |
| 1750825030 | Jordyn Ackerman | Marriage & Family Therapist | 900 E Gilbert Street, Cottage 4, San Bernardino, CA 92415 | 2016-12-06 |
| 1083063663 | San Bernardino County Department of Public Health | Public Health or Welfare | 1505 South D Street, San Bernardino, CA 92415 | 2016-06-06 |
| 1366821233 | Jodi Cerney | Counselor | 1950 S. Sunwest Lane, Suite #200, San Bernardino, CA 92415 | 2015-05-26 |
| 1427442268 | Yessenia Cruz | Case Manager/Care Coordinator | 780 E Gilbert St Bldg H, San Bernardino, CA 92415 | 2015-03-18 |
| 1861808859 | Hector Armando Ortega | Student in an Organized Health Care Education/Training Program | 1950 S. Sunwest Ln., Rialto, CA 92415 | 2014-07-10 |
| 1437564762 | Ashlee Barker | Marriage & Family Therapist | 900 E Gilbert St. Cottage 4, San Bernardino, CA 92415 | 2014-06-25 |
| 1669802708 | County of San Bernardino | In Home Supportive Care | 784 E Hospitality Ln, San Bernardino, CA 92415 | 2013-11-26 |
| Find all providers in zip 92415 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215547229 | Frank R Rivera | Counselor | 658 E Brier Dr Ste 350, San Bernardino, CA 92408-2875 | 2020-08-04 |
| 1528604501 | Rise Recovery | Counselor | 395 W 17th St, San Bernardino, CA 92405-4409 | 2019-11-25 |
| 1689210775 | Inland Empire Community Outreach Center | Counselor | 473 East Carnegie Drive, Suite 200, San Bernardino, CA 92408 | 2019-11-23 |
| 1881163434 | James Dean Anders | Counselor | 1481 Windsor Drive, San Bernardino, CA 92404 | 2018-11-13 |
| 1134644115 | Jorge Vasquez | Counselor | 222 W Hospitality Ln, San Bernardino, CA 92415-3536 | 2017-08-10 |
| 1902328578 | Kelly Canady | Counselor | 1100 N. D St., San Bernardino, CA 92410 | 2017-07-14 |
| 1093247215 | Traci Stockham | Counselor | 1925 W College Ave, Apt 185, San Bernardino, CA 92407-3371 | 2017-03-28 |
| 1760938534 | Michael Anthony Davis I | Counselor | 1475 E Date St Apt 118, San Bernardino, CA 92404-8227 | 2016-08-31 |
| 1770944704 | Cheryl Fox | Counselor | 560 N Arrowhead Ave Ste 1b, San Bernardino, CA 92401-1219 | 2016-03-18 |
| 1346600921 | Latasha Mcdonald | Counselor | 1365 North F Street, San Bernardino, CA 92405-0123 | 2016-02-25 |
| Find all providers in SAN BERNARDINO | ||||
| City | SAN BERNARDINO |
| Zip Code | 92415 |
Please comment or provide details below to improve the information on MR. MACK WILLIAM TOLLE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.