Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mike C Theodore, QMHA

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1316644735

Mike C Theodore, QMHA is an Addiction (Substance Use Disorder) Counselor in Beaverton, Oregon. Licensed in New York. Registered with an NPI since 2023.

Licensed in
NY
In the registry since
2023

Practice location Address checks out

17933 NW Evergreen Pkwy Ste 111
Beaverton, OR 97006-7452
Phone: (814) 243-0414
Fax: (814) 479-5906
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction (Substance Use Disorder) Counselor (primary) Taxonomy 101YA0400X · Licence 35007 (NY)

Record details

NPI number1316644735
Entity typeIndividual (Type 1)
GenderMale
Credentials QMHA
Sole proprietorNo
NPI enumeratedFebruary 15, 2023
Last updated in NPPESFebruary 15, 2023
Certification dateFebruary 15, 2023

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