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NPI Code Detail

MEDICARE: EMMA R MARK QMHA-I

MEDICARE: EMMA R MARK QMHA-I
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor24-QMHA-I-004246OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053992990
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMA R MARK QMHA-I
Provider Business Mailing Address
First Line : 211 SE CARUTHERS ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-4502
Country : US
Telephone Number : 503-224-1044
Fax Number : 503-621-2235
Provider Business Practice Location Address
First Line : 211 SE CARUTHERS ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-4502
Country : US
Telephone Number : 503-224-1044
Fax Number : 971-260-0355
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2021
Last Update Date : 04/03/2025

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Directions to “ EMMA R MARK QMHA-I” Practice Location

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