Individual
MS. KERRY MICHELLE MICKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA-I
Contact information
Practice address
850 SW 4TH ST STE 302, MADRAS, OR 97741-9629
(541) 475-6575
(541) 475-6196
Mailing address
340 NW 5TH ST STE 203, REDMOND, OR 97756-1869
(541) 516-4099
(541) 316-7422
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
24-QMHA-I-004726
OR
171M00000X
Case Manager/Care Coordinator
Primary
24-QMHA-I-004726
OR
175T00000X
Peer Specialist
—
OR
Other
Enumeration date
08/08/2022
Last updated
01/29/2025
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