JAMIE D GOTTLIEB CADC-R/QMHA-I NPI 1619625910

NPI Information

NPI: 1619625910
Provider Name: JAMIE D GOTTLIEB, CADC-R/QMHA-I
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
1310 SW 17TH AVE
PORTLAND, OR
ZIP 97201
Phone: (503) 231-2641
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Jamie D Gottlieb, CADC-R/QMHA-I is an addiction (substance use disorder) counselor in Portland, OR. Jamie D Gottlieb, CADC-R/QMHA-I NPI is 1619625910. 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:

1310 SW 17TH AVE
PORTLAND, OR
ZIP 97201-522
Phone: (503) 231-2641
Fax: (503) 467-4077

The enumeration date for this NPI number is 3/15/2022 and was last updated on 3/14/2024.

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	101YM0800X	Counselor	Mental Health	23-QMHA-I-003642	OREGON	No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)	T-23-2550	OREGON	Yes

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	500817750	MEDICAID	OREGON
2	500804360	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: 5/5/2024

NPI Synchronization or Removal

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