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