PATRICK G EAGLE STAFF


Address: 1310 Sw 17th Ave, Portland, OR 97201-2522
Phone: 5032312641

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).

Provider Overview

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

Taxonomy

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

Other Provider Identifier

State Issuer Identifier Type Code
OR 500761421 05
OR 500733968 05

Provider Secondary Practice Location

Address Telephone Number Fax Number
1631 Sw Columbia St, Portland, OR 972016025 5036212235
620 Ne 2nd St, Gresham, OR 970307514 9712743757 5039125740

Office Location

Street Address 1310 SW 17TH AVE
City PORTLAND
State OR
Zip Code 97201-2522

Providers in the same location

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

Providers in the same zip code

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 Information

Taxonomy Code 175T00000X
Grouping Other Service Providers
Classification Peer Specialist

Taxonomy Definition

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]

Providers in the same taxonomy and city

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

Competitor

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City PORTLAND
Zip Code 97201

Improve Information

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Dataset Information

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.

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