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Patrick G Eagle Staff, PWS/QMHP-C
Peer Specialist in Portland, Oregon
NPI 1316477441

Patrick G Eagle Staff is a Peer Specialist based in Portland, OR. Patrick G Eagle Staff practices in Portland, OR and has the professional credentials of PWS/QMHP-C. The NPI Number for Patrick G Eagle Staff is 1316477441 and holds a License No. 19-QMHPC-00380 (Oregon).

The current practice location address for Patrick G Eagle Staff is 1310 Sw 17Th Ave, Portland, OR and can be reached out via phone at 503-231-2641 and via fax at 503-467-4077.

Location: 1310 Sw 17Th Ave, Portland, OR, 97205-1715
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Provider Profile Details
NPI Number
1316477441
Provider Name
Patrick G Eagle Staff
Credential
PWS/QMHP-C
Provider Entity Type
Individual
Gender
Male
Address
1310 Sw 17Th Ave, Portland, OR, 97205-1715
Phone Number
503-231-2641
Fax Number
503-467-4077
Provider Enumeration Date
06/12/2017
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
500761421 05 OR
500733968 05 OR
institution
Provider Business Practice Location Address Details
Address
1310 Sw 17Th Ave
City
State
Zip
97201-2522
Phone Number
503-231-2641
Fax Number
503-467-4077
person
Provider Business Mailing Address Details
Address
1310 Sw 17Th Ave
City
State
Zip
97201-2522
Phone Number
503-231-2641
Fax Number
503-467-4077
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
THW0002219 (Oregon)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
License No.
19-QMHPC-00380 (Oregon)
Definition
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.
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