Provider Demographics
NPI:1649955063
Name:HUBLER, NICHOLAS BRIAN (QMHA-I)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:BRIAN
Last Name:HUBLER
Suffix:
Gender:M
Credentials:QMHA-I
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:HUBLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:QMHA-I
Mailing Address - Street 1:211 SE CARUTHERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4502
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:971-260-0355
Practice Address - Street 1:1438 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1140
Practice Address - Country:US
Practice Address - Phone:503-548-0346
Practice Address - Fax:503-232-5959
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25-QMHA-I-005045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500821020Medicaid