Individual
MYLDRED M SILVIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM/PSS/QMHA-I
Contact information
Practice address
620 NE 2ND ST, GRESHAM, OR 97030-7514
(971) 274-3757
(503) 912-5740
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16-CRM-217
OR
101YM0800X
Mental Health Counselor
19-QMHA-I-00473
OR
175T00000X
Peer Specialist
THW000001575
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500724283
—
OR
05
—
500760857
—
OR
Enumeration date
05/06/2016
Last updated
11/17/2020
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