Healthcare Provider Details

I. General information

NPI: 1710568183
Provider Name (Legal Business Name): BROOKE HEATHER BURCHARD QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE HEATHER BROSSARD

II. Dates (important events)

Enumeration Date: 04/17/2021
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15455 NW GREENBRIER PKWY STE 111
BEAVERTON OR
97006-7357
US

IV. Provider business mailing address

15455 NW GREENBRIER PKWY STE 111
BEAVERTON OR
97006-7357
US

V. Phone/Fax

Practice location:
  • Phone: 503-531-3434
  • Fax:
Mailing address:
  • Phone: 503-531-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC9765
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC9765
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: