Individual
SHYRA Q WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSWA/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) 224-4494
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
19-QMHA-I-01324
OR
104100000X
Social Worker
Primary
A13083
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500760476
—
OR
Enumeration date
04/29/2016
Last updated
08/01/2023
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