Provider Demographics
NPI:1215712393
Name:BAHRENBURG, WILLIAM STEWART III (QMHA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:STEWART
Last Name:BAHRENBURG
Suffix:III
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 SE 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-8414
Mailing Address - Country:US
Mailing Address - Phone:503-970-4806
Mailing Address - Fax:
Practice Address - Street 1:8040 SE 35TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-8414
Practice Address - Country:US
Practice Address - Phone:503-970-4806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health