Provider Demographics
NPI:1467064055
Name:UNSWORTH, MADISON (QMHP LPC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:UNSWORTH
Suffix:
Gender:F
Credentials:QMHP LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8311 SE 13TH AVE STE B3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7170
Mailing Address - Country:US
Mailing Address - Phone:971-266-4461
Mailing Address - Fax:971-386-1109
Practice Address - Street 1:8311 SE 13TH AVE STE B3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7170
Practice Address - Country:US
Practice Address - Phone:971-266-4461
Practice Address - Fax:971-386-1109
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7287101YM0800X, 101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional