Provider Demographics
NPI:1508910282
Name:DAVIS, JAMES K (QMHA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6918 N ALBINA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-1604
Mailing Address - Country:US
Mailing Address - Phone:503-753-0966
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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator