MEDICARE: BROOKE ANDERSON MSW, QMHP

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	372600000X	Adult Companion
4	1041C0700X	Clinical Social Worker	7480	OR

General Provider Information

NPI Number	:	1376725523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE ANDERSON MSW, QMHP

Provider Business Mailing Address
First Line	:	PO BOX 8459
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4212 SE DIVISION ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-1628
Country	:	US
Telephone Number	:	503-238-0705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	11/27/2024

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