Healthcare Provider Details

I. General information

NPI: 1033645429
Provider Name (Legal Business Name): AMBER R ESPINO-BARNES CADC II/QMHP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER R SCHUMANN CADC II/QMHP-C

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17645 NW SAINT HELENS RD
PORTLAND OR
97231-1729
US

IV. Provider business mailing address

1776 SW MADISON ST
PORTLAND OR
97205-1715
US

V. Phone/Fax

Practice location:
  • Phone: 503-621-1069
  • Fax: 503-621-0200
Mailing address:
  • Phone: 503-224-1044
  • Fax: 503-621-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18-11-13
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19-QMHPC-00048
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: