Provider Demographics
NPI:1437573029
Name:VIEIRA, MIA (QMHP)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:VIEIRA
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:HENKEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:998 LIBRARY CT
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:998 LIBRARY CT
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4041
Practice Address - Country:US
Practice Address - Phone:503-742-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL10550104100000X
372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker