Provider Demographics
NPI:1821597188
Name:FARMER, DAMIEN KYLE (QMHA)
Entity Type:Individual
Prefix:
First Name:DAMIEN
Middle Name:KYLE
Last Name:FARMER
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:NYKOLE-SUSANNE
Other - Middle Name:LOUISE
Other - Last Name:DURGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHA
Mailing Address - Street 1:3190 SW 185TH AVE APT 28
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97003-3269
Mailing Address - Country:US
Mailing Address - Phone:503-434-7462
Mailing Address - Fax:
Practice Address - Street 1:420 NE 5TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4603
Practice Address - Country:US
Practice Address - Phone:503-434-7462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator