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

Staley Wood Mims III, QMHPMED

Individual provider Mental Health Counselor · NPI 1023155207

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 St
Portland, OR 97212-2471
Phone: (503) 528-0757
Fax: (503) 528-0764
Show map & directions

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

Specialties & licences

Adult Companion (primary) Taxonomy 372600000X
Mental Health Counselor Taxonomy 101YM0800X

Record details

NPI number1023155207
Entity typeIndividual (Type 1)
GenderMale
Credentials QMHPMED
Sole proprietorYes
NPI enumeratedJanuary 30, 2007
Last updated in NPPESSeptember 11, 2025

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