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NPI Code Detail

MEDICARE: CASEY FRANCES BOHANNON CADC III, QMHP , MS

MEDICARE: CASEY FRANCES BOHANNON CADC III, QMHP , MS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor11-03-69OR
2101YA0400XAddiction (Substance Use Disorder) Counselor19-QMHPC-00309OR

General Provider Information

NPI Number : 1518095553
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY FRANCES BOHANNON CADC III, QMHP , MS
Provider Business Mailing Address
First Line : 2600 SE ORIENT DR APT 9
Second Line :
City : GRESHAM
State : OR
Zip : 97080-9086
Country : US
Telephone Number : 503-655-8401
Fax Number : 503-655-8429
Provider Business Practice Location Address
First Line : 6605 SE LAKE RD
Second Line :
City : MILWAUKIE
State : OR
Zip : 97222-2161
Country : US
Telephone Number : 503-655-8401
Fax Number : 503-655-8429
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 01/13/2026

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