PATRICK G EAGLE STAFF (NPI# 1316477441) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1316477441 |
Entity Type | Individual |
Full Name | PATRICK G EAGLE STAFF |
Credential | PWS/QMHP-C |
Practice Address |
1310 Sw 17th Ave Portland OR 97201-2522 |
Mailing Address |
1776 Sw Madison St Portland OR 97205-1715 |
Practice Telephone | 5032312641 |
Practice Fax Number | 5034674077 |
Mailing Telephone | 9713862278 |
Mailing Fax Number | 5032244494 |
Enumeration Date | 2017-06-12 |
Last Update Date | 2019-05-24 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 101YM0800X |
Counselor Specialization: Mental Health |
19-QMHPC-00380 | OR | Behavioral Health & Social Service Providers |
Y | 175T00000X | Peer Specialist | THW0002219 | OR | Other Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
OR | 500761421 | 05 | |
OR | 500733968 | 05 |
Address | Telephone Number | Fax Number |
---|---|---|
1631 Sw Columbia St, Portland, OR 972016025 | 5036212235 | |
620 Ne 2nd St, Gresham, OR 970307514 | 9712743757 | 5039125740 |
Street Address |
1310 SW 17TH AVE |
City | PORTLAND |
State | OR |
Zip Code | 97201-2522 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1164756722 | Amy A Thompson | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2009-09-29 |
1972127025 | Kristin A Schwing | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2020-06-04 |
1306473962 | Joanna Marie Jones | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2020-03-24 |
1962067470 | Jean Michelle Stonebraker | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2019-05-09 |
1053882829 | Kay M Cockerill | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2018-12-05 |
1245746742 | Tonya M Jones | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2017-12-19 |
1659890887 | Stacy L Mandzij | Social Worker | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2017-09-19 |
1699203851 | Angelique S Saxton | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2017-05-31 |
1447701305 | Lindsey R Miller | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2016-10-17 |
1801242730 | Tanya L Black | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2016-05-10 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1780206060 | Laura Elizabeth Jackson | Student in an Organized Health Care Education/Training Program | 2730 S Moody Ave, Portland, OR 97201 | 2020-05-10 |
1225659063 | Amanpreet Kaur | Student in an Organized Health Care Education/Training Program | Ohsu Physician Assistant Program, 2730 South Moody Ave. Mail Code: Cl5pa, Portland, OR 97201 | 2020-05-04 |
1063033801 | Aaron Kinn | Student in an Organized Health Care Education/Training Program | Ohsu Division of Physician Assistant Education - Cl5pa, 2730 Sw Moody Avenue, Portland, OR 97201 | 2020-05-04 |
1487275442 | Erin Aleen Ostlie-madden | Student in an Organized Health Care Education/Training Program | 2730 South Moody Ave, Portland, OR 97201 | 2020-04-30 |
1104446681 | Skycloud Psychiatry LLC | Nurse Practitioner | 106 South West Woods St, Portland, OR 97201 | 2020-04-24 |
1740825587 | Dalia Bayaa | Pharmacist | 325 Sw Harrison Street, Portland, OR 97201 | 2019-11-15 |
1780172619 | Susan Elizabeth Christian Barrios | Social Worker | 1505 Sw College St, Portland, OR 97201 | 2018-04-26 |
1730696576 | Fiona Everett | Counselor | 1703 Sw Clay St, Portland, OR 97201 | 2018-01-02 |
1437678844 | Akira Thomas Neilsen | Student in an Organized Health Care Education/Training Program | 1930 Sw River Drive, Unit 102, Portland, OR 97201 | 2017-09-18 |
1285171736 | Howard Mitchell | Technician, Other | 1110 Sw Clay Street Apt. 34, Portland, OR 97201 | 2017-01-23 |
Find all providers in zip 97201 |
Taxonomy Code | 175T00000X |
Grouping | Other Service Providers |
Classification | Peer Specialist |
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1487255576 | Thomas Roy Hooks | Peer Specialist | 1221 Sw 11th Ave Apt 102, Portland, OR 97205-2143 | 2020-11-04 |
1538773155 | Mamie Nzigire Zagabe | Peer Specialist | 605 Se Cesar Estrada Chavez Blvd, Portland, OR 97214 | 2020-09-01 |
1245896307 | Anthony James Hardy | Peer Specialist | 10336 Ne Wygant St, Portland, OR 97220-3368 | 2019-05-14 |
1881155596 | Laray Jermaine Thomas | Peer Specialist | 11509 Se Stephens St, Portland, OR 97216-3660 | 2019-03-26 |
1932684248 | Dorothy Joanna Burton | Peer Specialist | 3716 Ne Martin Luther King Blvd, Portland, OR 97212-1111 | 2018-10-02 |
1750886255 | Steven Wade | Peer Specialist | 4512 Ne Portland Hwy, Portland, OR 97218-1363 | 2018-03-27 |
1669991212 | Kimberly Jaye Randall | Peer Specialist | 17214 Se Division St Ste 2, Portland, OR 97236-1282 | 2017-09-14 |
1689103897 | Walter Bulter | Peer Specialist | 5257 Ne Martin Luther King Jr Blvd Ste 202, Portland, OR 97211-3283 | 2017-06-09 |
1306373543 | Brenda Kay Mitchell | Peer Specialist | 10373 Ne Hancock St Ste 132, Portland, OR 97220-3873 | 2017-05-18 |
1760914493 | Changing Perceptions | Peer Specialist | 1720 Nw Lovejoy St # 329, Portland, OR 97209-2346 | 2017-03-31 |
Find all providers in PORTLAND |
Please comment or provide details below to improve the information on PATRICK G EAGLE STAFF.
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.