Staley Wood Mims Iii, QMHP MED - Counselor in Portland, OR

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Staley Wood Mims Iii, QMHP MED is a Adult Companion based in Portland, Oregon. Staley Wood Mims Iii is licensed to practice in * (Not Available) (license number ) and his current practice location is 2330 Ne Siskiyou St, Portland, Oregon. He can be reached at his office (for appointments etc.) via phone at (503) 528-0757.

NPI number for Staley Wood Mims Iii is 1023155207 and his current mailing address is 3602 Se 28th Pl Apt 15, Portland, Oregon. He does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1023155207.

Contact Information

Staley Wood Mims Iii, QMHP MED
2330 Ne Siskiyou St,
Portland, OR 97212-2471
(503) 528-0757
(503) 528-0764

Map and Direction


Healthcare Provider's Profile

Full NameStaley Wood Mims Iii
GenderMale
SpecialityAdult Companion
Location2330 Ne Siskiyou St, Portland, Oregon
Accepts Medicare AssignmentsDoes not participate in Medicare Program. He may not accept medicare assignment.
  NPI Data:
  • NPI Number: 1023155207
  • Provider Enumeration Date: 01/30/2007
  • Last Update Date: 07/08/2007

Medical Identifiers

Medical identifiers for Staley Wood Mims Iii such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1023155207NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
101YM0800XCounselor - Mental Health (* (Not Available))Primary
372600000XAdult Companion (* (Not Available))Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Staley Wood Mims Iii is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Staley Wood Mims Iii, QMHP MED
3602 Se 28th Pl Apt 15,
Portland, OR 97202-3070

Ph: (503) 771-0968		Staley Wood Mims Iii, QMHP MED
2330 Ne Siskiyou St,
Portland, OR 97212-2471

Ph: (503) 528-0757

Reviews and Comments


Adult Companion in Portland, OR


Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.