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NPI Code Detail

MEDICARE: MATTHEW JARED GRAFFENBERGER QMHA

MEDICARE: MATTHEW JARED GRAFFENBERGER QMHA
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 Counselor25-QMHPC-001746OR

General Provider Information

NPI Number : 1073204632
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW JARED GRAFFENBERGER QMHA
Provider Business Mailing Address
First Line : 2577 NE COURTNEY DR
Second Line :
City : BEND
State : OR
Zip : 97701-7752
Country : US
Telephone Number : 541-322-7500
Fax Number : 541-322-7565
Provider Business Practice Location Address
First Line : 63311 JAMISON ST
Second Line :
City : BEND
State : OR
Zip : 97703-8288
Country : US
Telephone Number : 541-322-7500
Fax Number : 541-322-7565
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2023
Last Update Date : 01/23/2026

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