Provider Demographics
NPI:1225795057
Name:ENDERBY, KELSEY (QMHA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:ENDERBY
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 1:5240 NE ELAM YOUNG PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6438
Mailing Address - Country:US
Mailing Address - Phone:503-846-4555
Mailing Address - Fax:503-846-3305
Practice Address - Street 1:5240 NE ELAM YOUNG PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6438
Practice Address - Country:US
Practice Address - Phone:503-846-4555
Practice Address - Fax:503-846-3305
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21-QMHA-R-1169171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator