Provider Demographics
NPI:1609997493
Name:NASS, KATIE ROSE (QMHA)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:ROSE
Last Name:NASS
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 1:11695 SW TEAL BLVD
Mailing Address - Street 2:APT # B
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8081
Mailing Address - Country:US
Mailing Address - Phone:503-830-5732
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:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator