Provider Demographics
NPI:1952992943
Name:SHULTZ, RACHEL NICOLE (QMHA 2, CADC 2)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:NICOLE
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:QMHA 2, CADC 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SW ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-2438
Mailing Address - Country:US
Mailing Address - Phone:503-623-5226
Mailing Address - Fax:503-623-5326
Practice Address - Street 1:820 SW CHURCH ST STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-3146
Practice Address - Country:US
Practice Address - Phone:503-623-5226
Practice Address - Fax:503-623-5326
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
OR23-QMHA-LL-000151171M00000X
OR23-QMHA-II-000151101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor