JESSE N SPAIN CADC II/QMHA-I NPI 1477911477

NPI Information

NPI: 1477911477
Provider Name: JESSE N SPAIN, CADC II/QMHA-I
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
620 NE 2ND ST
GRESHAM, OR
ZIP 97030
Phone: (971) 274-3757
Get Directions

Jesse N Spain, CADC II/QMHA-I is an addiction (substance use disorder) counselor in Gresham, OR. Jesse N Spain, CADC II/QMHA-I NPI is 1477911477. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

620 NE 2ND ST
GRESHAM, OR
ZIP 97030-514
Phone: (971) 274-3757
Fax: (503) 912-5740

The enumeration date for this NPI number is 2/4/2016 and was last updated on 7/11/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	17-04-13	OREGON	Yes
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)	15-01-09	OREGON	No
3	101YM0800X	Counselor	Mental Health		OREGON	No
4	101YM0800X	Counselor	Mental Health	19-QMHA-I-00297	OREGON	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	500722603	MEDICAID	OREGON
2	500700056	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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