Individual
MICHELLE KATHERYN HATJES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSS/QMHA-R
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
101YM0800X
Mental Health Counselor
23-QMHA-R-4454
OR
175T00000X
Peer Specialist
Primary
THW00110295
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500828511
—
OR
Enumeration date
10/31/2023
Last updated
06/23/2024
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