KATRINA CAREEN MIRACLE (NPI# 1649784067) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649784067 |
| Entity Type | Individual |
| Full Name | KATRINA CAREEN MIRACLE |
| Credential | CRM |
| Practice Address |
10209 Se Division St Portland OR 97266-1372 |
| Mailing Address |
Po Box 16756 Portland OR 97292-0756 |
| Practice Telephone | 9715177048 |
| Mailing Telephone | 9715177048 |
| Mailing Fax Number | 5032082596 |
| Enumeration Date | 2017-11-21 |
| Last Update Date | 2020-01-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | 17-CRM-184 | OR | Other Service Providers |
| Street Address |
10209 SE DIVISION ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97266-1372 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548399322 | Corporate Health Nw | Nurse Practitioner | 10209 Se Division St, Portland, OR 97266-1327 | 2007-03-05 |
| 1215563895 | Ja'ray Tyrone Ceaser | Counselor | 10209 Se Division St, Portland, OR 97266-1372 | 2020-03-16 |
| 1790224806 | Michelle Coriell | Peer Specialist | 10209 Se Division St, Ste. D, Portland, OR 97266-1372 | 2017-02-22 |
| 1053862110 | Tara Blackinton | Peer Specialist | 10209 Se Division St, Portland, OR 97266-1372 | 2016-10-24 |
| 1154772382 | Virginia Rasmussen | Peer Specialist | 10209 Se Division St, Portland, OR 97266-1372 | 2016-06-29 |
| 1225489834 | Shannon Cole | Peer Specialist | 10209 Se Division St, Ste D, Portland, OR 97266-1372 | 2016-06-24 |
| 1083026645 | Ron Plumlee | Counselor | 10209 Se Division St, Bldg D, Portland, OR 97266-1372 | 2014-05-29 |
| 1265700884 | Fernando Jose Pena | Counselor | 10209 Se Division St, Bldg D, Portland, OR 97266-1372 | 2011-12-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528545969 | Willamette Pharmacy | Pharmacy | 10209 Se Division Build B Ste 100, Portland, OR 97266 | 2018-07-27 |
| 1992204697 | Sober Living Oregon Treatment Center | Clinic/Center | 10209 Se Division, Portland, OR 97266 | 2018-02-08 |
| 1699204024 | Malori Christine Butler | Registered Nurse | 7335 Se 85th Ave., Portland, OR 97266 | 2017-06-08 |
| 1487028882 | Emil Kunkel | Naturopath | 6318 Se 87th Ave, Portland, OR 97266 | 2015-11-23 |
| 1194195313 | Cory Hall-martin | Counselor | 10011 Se Division St #305, Portland, OR 97266 | 2015-09-30 |
| 1336517721 | Krispin Mayfield | Counselor | 10011 Se Division St., Suite 203, Portland, OR 97266 | 2015-09-02 |
| 1407247927 | Syrena Nicholson | Community Health Worker | 7721 Se 92nd Avenue, Apt K, Portland, OR 97266 | 2015-02-06 |
| 1659777886 | Berhanu Aynalem Mekbib | Adult Companion | 9125 Sw 55th, El Dorado, Portland, OR 97266 | 2014-11-17 |
| 1871930685 | Felicitas Amelia Penaloza | Behavioral Analyst | 9911 Se Mt.scott Boulevard, Portland, OR 97266 | 2013-06-03 |
| 1710237326 | Janna Renee Higgins | Case Manager/Care Coordinator | 9911 Se Mt. Scott Boulevard, Portland, OR 97266 | 2012-09-12 |
| Find all providers in zip 97266 | ||||
| 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 KATRINA CAREEN MIRACLE.
| 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.