SHYRA Q WADE (NPI# 1689029365) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689029365 |
| Entity Type | Individual |
| Full Name | SHYRA Q WADE |
| Credential | CRM/PSS/QMHA-I |
| 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 | 5036474077 |
| Mailing Telephone | 9713862278 |
| Mailing Fax Number | 5032244494 |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2019-05-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
15-CRM-180 | OR | Behavioral Health & Social Service Providers |
| N | 101YM0800X |
Counselor Specialization: Mental Health |
19-QMHA-I-01324 | OR | Behavioral Health & Social Service Providers |
| N | 175T00000X | Peer Specialist | THW000001257 | OR | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500760476 | 05 | |
| OR | 500712406 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1631 Sw Columbia St, Portland, OR 972016025 | 5032312641 | 5032311654 |
| 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 |
| 1316477441 | Patrick G Eagle Staff | Counselor | 1310 Sw 17th Ave, Portland, OR 97201-2522 | 2017-06-12 |
| 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 |
| 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 | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477163657 | Kevin Charles Reiser | Counselor | 2318 Ne Martin Luther King Blvd, Portland, OR 97212-3715 | 2020-08-03 |
| 1881203628 | Beau Curtiss | Counselor | 7916 Se Foster Rd Ste 203, Portland, OR 97206-4289 | 2020-07-28 |
| 1851916886 | Jonathan Cross | Counselor | 49 Montrose Ave Apt 3, Portland, ME 04103-2442 | 2020-06-16 |
| 1639703960 | Elizabeth Ann Anderson | Counselor | 1820 Sw Vermont St Ste J, Portland, OR 97219-1945 | 2020-02-25 |
| 1194356618 | Deforrest Kwesi Jackson | Counselor | 122 Ne 122nd Ave Ste 200, Portland, OR 97230-2103 | 2020-02-03 |
| 1760012942 | Jesse Decker | Counselor | 7015 N Boston Ave, Portland, OR 97217-5711 | 2020-01-16 |
| 1740829076 | Ryan Christianson | Counselor | 2707 Ne Flanders St, Portland, OR 97232-3159 | 2020-01-03 |
| 1083264477 | Kayla Rose Paris | Counselor | 420 Cumberland Ave, Portland, ME 04101-2823 | 2019-09-17 |
| 1275193260 | Anna Khval | Counselor | 1500 Se 122nd Ave, Portland, OR 97233-1207 | 2019-06-20 |
| 1841855301 | Portland Opioid Health Home | Counselor | 48 Free St., Mezzanine Level, Portland, ME 04101 | 2019-05-09 |
| Find all providers in PORTLAND | ||||
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| 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.