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NPI Code Detail

MEDICARE: JEFFREY TODD KITSON CADCI, QMHA

MEDICARE: JEFFREY TODD KITSON CADCI, QMHA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorOR
2171M00000XCase Manager/Care CoordinatorOR

General Provider Information

NPI Number : 1881877009
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY TODD KITSON CADCI, QMHA
Provider Business Mailing Address
First Line : 2521 SE 74TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97206-1150
Country : US
Telephone Number : 503-597-3902
Fax Number : 503-597-3903
Provider Business Practice Location Address
First Line : 8915 SW CENTER ST
Second Line :
City : TIGARD
State : OR
Zip : 97223-6307
Country : US
Telephone Number : 503-726-3740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2007
Last Update Date : 01/16/2018

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