Individual
JEREMY RANDOLPH NAISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC-II, QMHA-II
Contact information
Practice address
1712 NE SANDY BLVD, PORTLAND, OR 97232-2851
(503) 496-6839
Mailing address
1712 NE SANDY BLVD, PORTLAND, OR 97232-2851
(971) 712-9258
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
23-QMHA-I-003747
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
23-05-20277
OR
Other
Enumeration date
04/06/2021
Last updated
04/21/2025
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