PATRICK G EAGLE STAFF PWS/QMHP-C
NPI 1316477441
Peer Specialist in Portland, OR

Q: What is Patrick Eagle Staff's NPI number?

The NPI number for Patrick Eagle Staff is 1316477441. It was assigned to this individual provider in the NPPES registry on June 12, 2017.

Q: What is Patrick Eagle Staff's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

Active since June 12, 2017

1310 SW 17TH AVE, PORTLAND, OR 97201(503) 231-2641(503) 467-4077 Get Directions Write a Review

NPPES record last updated: May 24, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 24, 2019, Apr 16, 2019, Apr 9, 2019 and 3 more (6 updates tracked since 2017).

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About Patrick G Eagle Staff Pws/qmhp-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PATRICK G EAGLE STAFF PWS/QMHP-C (NPI 1316477441) is an individual peer specialist in Portland, Oregon, licensed in Oregon (THW0002219) and active in the NPI registry since June 2017. He maintains 2 additional practice locations.

NPPES Registry Identity

NPI1316477441

Entity TypeIndividualMale

Primary Taxonomy175T00000X

Provider Legal NamePATRICK G EAGLE STAFFCredential: PWS/QMHP-C

Location Address1310 SW 17TH AVEPortland, OR 97201-2522

Mailing Address1776 Sw Madison StPortland, OR 97205-1715 · (971) 386-2278 · Fax (503) 224-4494

Phone(503) 231-2641

Fax(503) 467-4077

Sole ProprietorNo

Enumeration DateJune 12, 2017

Last NPPES UpdateMay 24, 20196 updates tracked since enumeration

✔ NPI 1316477441 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPeer SpecialistOther Service Providers

Taxonomy Code175T00000X

License✔ Licensed in OR · THW0002219

Definition

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License 19-QMHPC-00380 (OR)

1310 SW 17TH AVE, Portland, OR 97201

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Secondary Practice Locations 2

Location 1620 NE 2nd StGresham, OR 97030-7514 · Phone (971) 274-3757 · Fax (503) 912-5740

Location 21631 SW Columbia StPortland, OR 97201-6025 · Phone (503) 621-2235

Other Identifiers 2

Medicaid500761421OR

Medicaid500733968OR

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DONNA M TURQUOISE QMHP-C

Counselor (Mental Health)