Provider Demographics
NPI:1407994312
Name:GUSEH, JOSEPH S (QMHP)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:S
Last Name:GUSEH
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4931 NE ALBERTA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-2025
Mailing Address - Country:US
Mailing Address - Phone:503-997-1991
Mailing Address - Fax:
Practice Address - Street 1:5023 NE KILLINGSWORTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-1915
Practice Address - Country:US
Practice Address - Phone:503-402-8117
Practice Address - Fax:503-284-6585
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker