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NPI Code Detail

MEDICARE: KELSEY BRENNA MOVCHAN PSS, CRM, QMHA-R

MEDICARE: KELSEY BRENNA MOVCHAN PSS, CRM, QMHA-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 Counselor25-QMHA-R-7290OR
2175T00000XPeer Specialist111927OR
3101YA0400XAddiction (Substance Use Disorder) Counselor25-CRM-4213OR

General Provider Information

NPI Number : 1861250649
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY BRENNA MOVCHAN PSS, CRM, QMHA-R
Provider Business Mailing Address
First Line : 211 SE CARUTHERS ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-4502
Country : US
Telephone Number : 971-217-9008
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 : 503-621-0200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2024
Last Update Date : 04/27/2026

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