Healthcare Provider Details

I. General information

NPI: 1780320812
Provider Name (Legal Business Name): ARIEL MORAN QMHA-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 NW HUGHWOOD CT
ROSEBURG OR
97471-8844
US

IV. Provider business mailing address

550 S STATE ST UNIT 190
SUTHERLIN OR
97479-8514
US

V. Phone/Fax

Practice location:
  • Phone: 541-673-3985
  • Fax:
Mailing address:
  • Phone: 541-788-4574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25-QMHP-R-3735
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number23-QMHA-I-004057
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberTHW000106745
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberA16803
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: