Provider Demographics
NPI:1720667702
Name:NAISH, JEREMY RANDOLPH (CADC-II, QMHA-II)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:RANDOLPH
Last Name:NAISH
Suffix:
Gender:
Credentials:CADC-II, QMHA-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 NE SANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2851
Mailing Address - Country:US
Mailing Address - Phone:971-712-9258
Mailing Address - Fax:
Practice Address - Street 1:1712 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2851
Practice Address - Country:US
Practice Address - Phone:503-496-6839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-05-20277101YA0400X
OR23-QMHA-I-003747101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)