Provider Demographics
NPI:1720389299
Name:MACHADO, KJERSTI (MA, LPC, QMHP)
Entity Type:Individual
Prefix:
First Name:KJERSTI
Middle Name:
Last Name:MACHADO
Suffix:
Gender:F
Credentials:MA, LPC, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 SW 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1703
Mailing Address - Country:US
Mailing Address - Phone:503-416-3670
Mailing Address - Fax:
Practice Address - Street 1:825 NE MULTNOMAH ST
Practice Address - Street 2:SUITE 1400
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2135
Practice Address - Country:US
Practice Address - Phone:503-488-7214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health