=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295233872
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALNISSIA L KNOX QMHA-I
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2018
-----------------------------------------------------
Last Update Date | 05/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 620 NE 2ND ST
-----------------------------------------------------
City | GRESHAM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97030-7514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-274-3757
-----------------------------------------------------
Fax | 503-912-5740
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 SE CARUTHERS ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97214-4502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-224-1044
-----------------------------------------------------
Fax | 971-260-0355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 19-QMHA-I-01977
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------