Healthcare Provider Details

I. General information

NPI: 1265980148
Provider Name (Legal Business Name): LORETTA SHAH QMHP-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4585 SW 185TH AVE
ALOHA OR
97078-1557
US

IV. Provider business mailing address

4585 SW 185TH AVE
ALOHA OR
97078-1557
US

V. Phone/Fax

Practice location:
  • Phone: 503-591-9280
  • Fax:
Mailing address:
  • Phone: 503-591-9280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25-QMHP-R-3398
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: