Provider Demographics
NPI:1225727811
Name:LINDO, JULET A (QMHA-R)
Entity type:Individual
Prefix:
First Name:JULET
Middle Name:A
Last Name:LINDO
Suffix:
Gender:
Credentials:QMHA-R
Other - Prefix:
Other - First Name:KURT
Other - Middle Name:RYAN
Other - Last Name:LINDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:QMHA-R
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 1:620 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7514
Practice Address - Country:US
Practice Address - Phone:971-274-3757
Practice Address - Fax:503-912-5740
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-QMHA-R-3723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500819452Medicaid