Provider Demographics
NPI:1114572831
Name:DAVIS, DUSTIN JAMES (QMHA, CPT)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JAMES
Last Name:DAVIS
Suffix:
Gender:M
Credentials:QMHA, CPT
Other - Prefix:
Other - First Name:DUSTIN
Other - Middle Name:JAMES
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:QMHA, CPT
Mailing Address - Street 1:2034 COLUMBIA BLVD # 507
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-1737
Mailing Address - Country:US
Mailing Address - Phone:503-729-2384
Mailing Address - Fax:855-240-3947
Practice Address - Street 1:4660 NE BELKNAP CT STE 101H
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-8403
Practice Address - Country:US
Practice Address - Phone:503-729-2384
Practice Address - Fax:855-240-3947
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)