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).
| 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 |
| 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 |
| Identifier | State | Issuer | Type Code |
|---|---|---|---|
| THW2156 | OR | MEDICAID |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 209 Sw Fourth Ave, Suite 520, Portland, OR 97204, US | 5415569195 | |
| 445 Port Ave, Saint Helens, OR 970516225, US | 5415569195 | |
| 707 Ne Couch St, Portland, OR 972322922, US | 5035424603 | 5032336093 |
| Street Address | 209 SW FOURTH AVE, SUITE 520 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97204 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1902278823 | Kristina Valdez | Massage Therapist | 319 Sw Washington St, Ste 1001, Portland, OR 97204 | 2015-10-30 |
| 1003065160 | Michael Ann Benchoff | Counselor | 421 Sw Oak Street, Suite 520, Portland, OR 97204 | 2008-09-15 |
| 1619226941 | Tam Hoang | Pharmacist | 421 Sw Oak St., Ste. 210, Portland, OR 97204 | 2012-08-31 |
| 1255614624 | Jaclyn Rene Jones | Nurse Practitioner - Family | 601 Sw 4th Ave, Portland, OR 97204 | 2011-09-22 |
| 1588940001 | Susan Marie Yoon | Behavioral Analyst | 401 Sw Oak Street, Portland, OR 97204 | 2011-10-28 |
| 1407148398 | Cristianne Paulsen | Dental Hygienist | 426 Sw Stark, 9th Floor, Portland, OR 97204 | 2011-05-10 |
| 1013321470 | Amber S Henin | Counselor - Addiction (Substance Use Disorder) | 520 Sw Yamhill St Ste 345, Portland, OR 97204 | 2014-06-13 |
| 1245545219 | Sarah Catherine Stanzione | Social Worker | 421 Sw Oak Street, Portland, OR 97204 | 2010-08-13 |
| 1124472055 | Stuart Malcolm | Student in an Organized Health Care Education/Training Program | 601 Sw 4th Ave, Portland, CA 97204 | 2016-04-18 |
| Find all in zip 97204 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| 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. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932843828 | Nicole Teresa Quarles | Counselor | 4531 Se Belmont St Ste 118, Portland, OR 97215-1675 | 2022-04-26 |
| 1578207460 | Garrison Alben Cox | Counselor | 4531 Se Belmont St Ste 117and, Portland, OR 97215-1699 | 2022-04-26 |
| 1487398376 | Nicolette Sutherland | Counselor | 4531 Se Belmont St, Stes. #117 and #118, Portland, OR 97215 | 2022-04-26 |
| 1386388395 | Douglas M Mitchell | Counselor | 1600 Se Ankeny St, Portland, OR 97214-1448 | 2022-04-25 |
| 1528701422 | Amanda L Best | Counselor | 2435 Se 76th Ave, Portland, OR 97206-1007 | 2022-04-18 |
| 1427791318 | Mitchell Passadore | Counselor | 32 Ne 11th Ave, Portland, OR 97232-3001 | 2022-04-18 |
| 1255073177 | Katherine Marie Kovacich Blackmore | Counselor | 3415 Se Powell Blvd, Portland, OR 97202-3371 | 2022-04-11 |
| 1225786478 | Summer Steinwand | Counselor | 1219 Se Lafayette St Ste 100, Portland, OR 97202-3802 | 2022-03-16 |
| 1083362503 | Kyan Jerie Osher | Counselor | 909 Sw Saint Clair Ave, Portland, OR 97205-1300 | 2022-03-14 |
| 1043963663 | Ileap | Counselor | 1821 Se Cesar E Chavez Blvd, Portland, OR 97214-5215 | 2022-02-02 |
| Find all providers in PORTLAND | ||||
| City | PORTLAND |
| Zip Code | 97204 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528713328 | Desiree Wright · Desiree Smith | Registered Nurse | 4030 Gumwood Ln, Knoxville, TN 37921-1364 | 2022-02-21 |
| 1063163111 | Dionne Desiree Bademosi · Dionne Desiree Jones | Nurse Practitioner - Primary Care | 308 Nj- 38 E, Moorestown, NJ 08057 | 2022-01-11 |
| 1851033815 | Desiree Rene Stewart · Desiree Rene Johnson | Counselor - Addiction (Substance Use Disorder) | 115 S Reynolds Rd, Toledo, OH 43615-6958 | 2022-04-11 |
| 1720723919 | Desiree Michele Dace · Desiree Michele Williams | Health Educator | 2705 Marshall Ave, Granite City, IL 62040-5823 | 2022-05-02 |
| 1508516063 | Desiree Vera | Behavior Technician | 100 Governors Trce Ste 101, Peachtree City, GA 30269-4853 | 2022-03-28 |
| 1255080909 | Desiree Rodriguez | Behavior Technician | 3455 Peachtree Rd Ne Fl 5, Atlanta, GA 30326-3254 | 2022-03-21 |
| 1063161354 | Desiree Ross | Home Health Aide | 203 E Woodland Rd, Marshall, TX 75672-7239 | 2022-03-22 |
| 1215686514 | Desiree B Cruz | Behavior Technician | 880 W Lambert Rd Apt C101, La Habra, CA 90631-8942 | 2022-03-22 |
| 1992466163 | Desiree Mendoza | Behavior Technician | 135 W 26th St Apt 3, Hialeah, FL 33010-1620 | 2022-01-10 |
| 1508506544 | Desiree Pannier | Counselor - Professional | 130 Critchlow School Rd, Renfrew, PA 16053-9437 | 2022-03-29 |
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| 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.