Healthcare Provider Details

I. General information

NPI: 1881877009
Provider Name (Legal Business Name): JEFFREY TODD KITSON CADCI, QMHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 SW CENTER ST
TIGARD OR
97223-6307
US

IV. Provider business mailing address

2521 SE 74TH AVE
PORTLAND OR
97206-1150
US

V. Phone/Fax

Practice location:
  • Phone: 503-726-3740
  • Fax:
Mailing address:
  • Phone: 503-597-3902
  • Fax: 503-597-3903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: