Provider Demographics
NPI:1164556817
Name:MARCELL, YEEKA J (QMHA)
Entity Type:Individual
Prefix:
First Name:YEEKA
Middle Name:J
Last Name:MARCELL
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15900 NE SANDY BLVD APT 44
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5191
Mailing Address - Country:US
Mailing Address - Phone:971-570-0421
Mailing Address - Fax:
Practice Address - Street 1:2270 SE CESAR E CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5916
Practice Address - Country:US
Practice Address - Phone:503-963-8337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR372600000XOtherADULT COMPANION