Provider Demographics
NPI:1790413821
Name:MICKEL, KERRY MICHELLE (QMHA-R)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:MICHELLE
Last Name:MICKEL
Suffix:
Gender:F
Credentials:QMHA-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 NW 5TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1869
Mailing Address - Country:US
Mailing Address - Phone:541-516-4099
Mailing Address - Fax:541-316-7422
Practice Address - Street 1:850 SW 4TH ST STE 302
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-9629
Practice Address - Country:US
Practice Address - Phone:541-475-6575
Practice Address - Fax:541-475-6196
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-QMHA-R-2636101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health