person
Staley Wood Mims III, QMHPMED
Adult Companion in Portland, Oregon
NPI 1023155207

Staley Wood Mims III is an Adult Companion based in Portland, OR. Staley Wood Mims III practices in Portland, OR and has the professional credentials of QMHPMED. The NPI Number for Staley Wood Mims III is 1023155207 and holds a License No. (Oregon).

The current practice location address for Staley Wood Mims III is 2330 Ne Siskiyou St, Portland, OR and can be reached out via phone at 503-528-0757 and via fax at 503-528-0764.

Location: 2330 Ne Siskiyou St, Portland, OR, 97202-3070
person
Provider Profile Details
NPI Number
1023155207
Provider Name
Staley Wood Mims III
Credential
QMHPMED
Provider Entity Type
Individual
Gender
Male
Address
2330 Ne Siskiyou St, Portland, OR, 97202-3070
Phone Number
503-528-0757
Fax Number
503-528-0764
Provider Enumeration Date
01/30/2007
Last Update Date
03/08/2024
institution
Provider Business Practice Location Address Details
Address
2330 Ne Siskiyou St
City
State
Zip
97212-2471
Phone Number
503-528-0757
Fax Number
503-528-0764
person
Provider Business Mailing Address Details
Address
2330 Ne Siskiyou St
City
State
Zip
97212-2471
Phone Number
503-528-0757
Fax Number
503-528-0764
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Nursing Service Related Providers
Classification
Adult Companion
Speciality
-
Taxonomy
License No.
()
Definition
An individual who provides supervision, socialization, and non-medical care to a functionally impaired adult. Companions may assist or supervise the individual with such tasks as meal preparation, laundry and shopping, but do not perform these activities as discrete services. These services are provided in accordance with a therapeutic goal in the plan of care.
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