MODUPE DESIREE BANSILE
DESIREE BANSILE · Counselor

Address: 209 Sw Fourth Ave, Suite 520, Portland, OR 97204

MODUPE DESIREE BANSILE (NPI# 1790133031) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1790133031
Entity Type Individual
Full Name MODUPE DESIREE BANSILE
Other Name DESIREE BANSILE (Other Name)
Gender Female
Practice Address 209 Sw Fourth Ave, Suite 520
Portland
OR 97204
US
Practice Telephone 5415569195
Mailing Address 11073 Se Main St
Milwaukie
OR 97222
US
Mailing Telephone 5415569195
Enumeration Date 2016-05-26
Last Update Date 2018-10-30
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification Taxonomy Group License Number License State Grouping
N 101Y00000X Counselor Behavioral Health & Social Service Providers
Y 175T00000X Peer Specialist THW2156 OR Other Service Providers

Other Provider Identifiers

Identifier State Issuer Type Code
THW2156 OR MEDICAID

Provider Secondary Practice Locations

Address Telephone Number Fax Number
707 Ne Couch St, Portland, OR 972322922, US 5035424603 5032336093
445 Port Ave, Saint Helens, OR 970516225, US 5415569195
209 Sw Fourth Ave, Suite 520, Portland, OR 97204, US 5415569195

Office Location

Street Address 209 SW FOURTH AVE, SUITE 520
City PORTLAND
State OR
Zip Code 97204

Providers in the same zip code prefix

NPI Name Taxonomy Address Enumeration
1245545219 Sarah Catherine Stanzione Social Worker 421 Sw Oak Street, Portland, OR 97204 2010-08-13
1528302197 Multnomah County · Health Share of Oregon Multnomah Mental Health Community/Behavioral Health 421 Sw Oak, Suite 520, Portland, OR 97204 2012-11-20
1922662352 Sleep Management, L.L.C. · Viemed Respiratory Therapist, Registered - Home Health 1050 Sw 6th Avenue, Suite 1100 Office # 52, Portland, OR 97204 2019-05-01
1619226941 Tam Hoang Pharmacist 421 Sw Oak St., Ste. 210, Portland, OR 97204 2012-08-31
1134204266 Victoria Louise Argo Acupuncturist 310 Sw 4th Ave., Suite 415, Portland, OR 97204 2006-10-26
1902278823 Kristina Valdez Massage Therapist 319 Sw Washington St, Ste 1001, Portland, OR 97204 2015-10-30
1023532157 Darian Finley-Garcia Counselor - Mental Health 421 Sw Oak St, Portland, OR 97204 2017-07-31
1699896274 Julie Anne Oyemaja Counselor - Mental Health 421 Sw Oak St., Ste. 210, Portland, OR 97204 2007-04-02
1952737736 Hessler-Cohen Enterprises LLC · Acupuncture & Diagnostics Center Acupuncturist 310 Sw 4rth Avenue, Suite 725, Portland, OR 97204 2013-09-24
1144583378 Angela Nicole Johnson Physical Therapist 555 Sw Oak Street, Portland, OR 97204 2012-06-22
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Taxonomy Information

Taxonomy Code 101Y00000X
Grouping Behavioral Health & Social Service Providers
Classification Counselor

Taxonomy Definition

A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification.
Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1467121129 Olivia Siulagi Counselor 4531 Se Belmont St Ste 117and, Portland, OR 97215-1699 2021-09-07
1124796685 Mark Andrew Stouffer Counselor 4262 N Vancouver Ave, #311, Portland, OR 97217 2021-08-31
1184290413 Courtney A Watson Counselor 2951 Se Taylor St, Portland, OR 97214-4032 2021-05-27
1295326262 David Burnell Counselor 3650 Ne Mallory Ave Apt 101, Portland, OR 97212-3088 2021-02-01
1073102869 Brian Michael Thatcher Counselor Lifeworks Northwest, 5415 Sw Westgate Drive, Portland, OR 97221 2021-01-15
1104427160 Kristine Lee Jones Counselor 2628 Se 87th Ave, Portland, OR 97266-1530 2020-11-05
1932711322 Rachel Wilson Counselor 1020 Se 7th Ave # 14283, Portland, OR 97214-2387 2020-08-18
1851919906 Anjana Rajan Counselor Lifeworks Northwest, 14600 Nw Cornell Rd, Portland, OR 97229 2020-07-06
1972124196 Outside In Counselor 16144 E Burnside St, Portland, OR 97233-3520 2020-04-28
1962022350 Nicole Blake · Nicole Jewell Counselor 400 Commercial St, Portland, ME 04101-4660 2020-04-25
Find all providers in PORTLAND

Competitor

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City PORTLAND
Zip Code 97204

Providers with similar names

NPI Name Taxonomy Address Enumeration
1124795653 Desiree Burnett · Desiree Watts Case Manager/Care Coordinator 1351 Whetstone Dr, Greenfield, IN 46140-2680 2021-08-24
1164092342 Desiree Hoetmer · Desiree Hoetmer-Vasquez Social Worker 1646 E 2nd St N Ste 100, Wichita, KS 67214-4129 2021-06-29
1720661416 Desiree Trina Mieure · Desiree Mieure Occupational Therapist 6561 Gladesmore Ave., Arcadia, CA 91007-7818 2021-04-30
1366030975 Desiree Lynn Lyons Howard · Desiree Lynn Lyons Physical Therapist 635 W Galway St, Rialto, CA 92377-4577 2021-01-08
1528630357 Desiree Ann Self Behavior Technician 244 S Silverwood Way, Eagle, ID 83616-6165 2021-07-12
1376136259 Desiree Ryan Community Health Worker 5 Mount Hermon Rd, Buckhannon, WV 26201-7029 2021-02-11
1790352938 Desiree G Rosales Behavior Technician 7292 Pepperwood Knoll Ln Apt 253, Sacramento, CA 95842-4674 2021-06-07
1205412236 Desiree Aldag Case Manager/Care Coordinator 3218 E Colonial Dr Ste G, Orlando, FL 32803-5125 2021-03-21
1881283653 Desiree Strother Counselor - Mental Health 1902 Marlberry Ln, Houston, TX 77084-4531 2021-01-15
1477121937 Desiree Johnson Clinical Nurse Specialist - Long-Term Care 1105 N Boeke Rd, Evansville, IN 47711-4905 2021-06-11

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.