Healthcare Provider Details

I. General information

NPI: 1639088263
Provider Name (Legal Business Name): DES'SMEN MAURICE POOLER QMHA-R
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/15/2026
Certification Date: 09/01/2026
Deactivation Date: 09/02/2026
Reactivation Date: 09/15/2026

III. Provider practice location address

1050 SW 6TH AVE STE 1100
PORTLAND OR
97204-1153
US

IV. Provider business mailing address

2200 PASEO VERDE PKWY STE 190
HENDERSON NV
89052-2703
US

V. Phone/Fax

Practice location:
  • Phone: 702-589-4871
  • Fax: 702-589-4872
Mailing address:
  • Phone: 702-589-4871
  • Fax: 702-589-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number26-QMHA-R-9158
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number26-QMHA-R-9158
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: