Healthcare Provider Details

I. General information

NPI: 1952992943
Provider Name (Legal Business Name): RACHEL NICOLE SHULTZ QMHA 2, CADC 2
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SW CHURCH ST STE 100
DALLAS OR
97338-3146
US

IV. Provider business mailing address

1350 SW ELLIS ST
DALLAS OR
97338-2438
US

V. Phone/Fax

Practice location:
  • Phone: 503-623-5226
  • Fax: 503-623-5326
Mailing address:
  • Phone: 503-623-5226
  • Fax: 503-623-5326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number23-QMHA-II-000151
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number23-QMHA-LL-000151
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: