Provider Demographics
NPI:1619583622
Name:KAYHANI, ALEXANDER A (LMSW/QMHP-R)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:A
Last Name:KAYHANI
Suffix:
Gender:M
Credentials:LMSW/QMHP-R
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:A
Other - Last Name:KAYHANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW/QMHP-R
Mailing Address - Street 1:1776 SW MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1715
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:503-621-2235
Practice Address - Street 1:1631 SW COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-6025
Practice Address - Country:US
Practice Address - Phone:503-231-2641
Practice Address - Fax:503-231-1654
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121746-01104100000X
ORM15103104100000X
OR24-QMHP-R-2639101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500832446Medicaid