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NPI Code Detail

MEDICARE: DAVID LEVI-KIMBROUGH QHMA-R

MEDICARE: DAVID LEVI-KIMBROUGH QHMA-R
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 Counselor26-QMHA-R-8723OR

General Provider Information

NPI Number : 1295402790
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID LEVI-KIMBROUGH QHMA-R
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 : 971-260-0355
Provider Business Practice Location Address
First Line : 3636 NE BROADWAY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97232-1823
Country : US
Telephone Number : 503-548-0346
Fax Number : 503-232-5959
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2021
Last Update Date : 06/03/2026

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Directions to “ DAVID LEVI-KIMBROUGH QHMA-R” Practice Location

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