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
Other Name DESIREE BANSILE (Other Name)
Gender Female
Practice Address 209 Sw Fourth Ave, Suite 520
OR 97204
Practice Telephone 5415569195
Mailing Address 11073 Se Main St
OR 97222
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

Other Provider Identifiers

Identifier State Issuer Type Code

Provider Secondary Practice Locations

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

Office Location

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

Providers in the same zip code prefix

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 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
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


Search similar providers

Zip Code 97204

Providers with similar names

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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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.