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MODUPE DESIREE BANSILE
NPI 1790133031
Peer Specialist in Portland, OR

Active since May 26, 2016
209 SW FOURTH AVE, SUITE 520, PORTLAND, OR 97204(541) 556-9195 Get Directions Write a Review

NPPES record last updated: October 30, 2018. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Oct 30, 2018, Mar 17, 2018 (2 updates tracked since 2018).

About Modupe Desiree Bansile NPPES

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

MODUPE DESIREE BANSILE (NPI 1790133031) is an individual peer specialist in Portland, Oregon, licensed in Oregon (THW2156) and active in the NPI registry since May 2016. She maintains 3 additional practice locations.

NPPES Registry Identity

NPI1790133031
Entity TypeIndividualFemale
Primary Taxonomy175T00000X
Provider Legal NameMODUPE DESIREE BANSILE
Location Address209 SW FOURTH AVE, SUITE 520Portland, OR 97204
Mailing Address11073 Se Main StMilwaukie, OR 97222 · (541) 556-9195
Phone(541) 556-9195
Sole ProprietorYes
Enumeration DateMay 26, 2016
Last NPPES UpdateOctober 30, 20182 updates tracked since enumeration
✔ NPI 1790133031 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 · THW2156
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 ListedCounselorTaxonomy 101Y00000X
209 SW FOURTH AVE, SUITE 520, Portland, OR 97204
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Other Names 1

Other Name (5)Desiree Bansile

Secondary Practice Locations 3

Location 1445 Port AveSaint Helens, OR 97051-6225 · Phone (541) 556-9195
Location 2707 NE Couch StPortland, OR 97232-2922 · Phone (503) 542-4603 · Fax (503) 233-6093
Location 3209 SW Fourth Ave, Suite 520Portland, OR 97204 · Phone (541) 556-9195

Other Identifiers 1

MedicaidTHW2156OR

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Modupe Bansile's NPI number?

The NPI number for Modupe Bansile is 1790133031. It was assigned to this individual provider in the NPPES registry on May 26, 2016.

Where is Modupe Bansile located?

Modupe Bansile practices at 209 SW Fourth Ave, Suite 520, Portland, OR 97204. The listed phone number is (541) 556-9195.

What is Modupe Bansile's specialty?

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

When was this NPI record last updated?

The NPPES record for Modupe Bansile was last updated on October 30, 2018. NPI Profile syncs with the weekly NPPES data releases published by CMS.