Provider Demographics
NPI:1306694039
Name:KEMBLE, JUSTIN (QMHP)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:KEMBLE
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 60TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-3710
Mailing Address - Country:US
Mailing Address - Phone:503-302-9416
Mailing Address - Fax:
Practice Address - Street 1:9600 SW OAK ST STE 500&520
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6583
Practice Address - Country:US
Practice Address - Phone:971-364-8069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-QMHP-R-28731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical