Staley Wood Mims III, QMHPMED
Staley Wood Mims III, QMHPMED is a Mental Health Counselor in Portland, Oregon. Practices as a sole proprietor. Registered with an NPI since 2007.
- In the registry since
- 2007
- Specialties on file
- 2
Practice location Address checks out
2330 NE Siskiyou StPortland, OR 97212-2471
Phone: (503) 528-0757
Fax: (503) 528-0764
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Specialties & licences
| Adult Companion (primary) | Taxonomy 372600000X |
|---|---|
| Mental Health Counselor | Taxonomy 101YM0800X |
Record details
| NPI number | 1023155207 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | QMHPMED |
| Sole proprietor | Yes |
| NPI enumerated | January 30, 2007 |
| Last updated in NPPES | September 11, 2025 |
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