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NPI Code Detail

MEDICARE: MS. THERESA M DESOUZA CADCII, QHMA-I

MEDICARE: MS. THERESA M DESOUZA CADCII, QHMA-I
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) Counselor16-R-26OR
2101YM0800XMental Health Counselor25-QHMA-I005194OR

General Provider Information

NPI Number : 1902046220
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. THERESA M DESOUZA CADCII, QHMA-I
Provider Business Mailing Address
First Line : 389 SW SCALEHOUSE CT
Second Line :
City : BEND
State : OR
Zip : 97702-3241
Country : US
Telephone Number : 541-306-4446
Fax Number : 541-550-2011
Provider Business Practice Location Address
First Line : 389 SW SCALEHOUSE CT
Second Line :
City : BEND
State : OR
Zip : 97702-3241
Country : US
Telephone Number : 541-306-4466
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2009
Last Update Date : 11/13/2025

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