Provider Demographics
NPI:1144250168
Name:PROJECT QUEST
Entity type:Organization
Organization Name:PROJECT QUEST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LEELA
Authorized Official - Middle Name:JACKIE
Authorized Official - Last Name:LONGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-238-5203
Mailing Address - Street 1:PO BOX 86160
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97286-0160
Mailing Address - Country:US
Mailing Address - Phone:503-238-5203
Mailing Address - Fax:503-238-5202
Practice Address - Street 1:3231 SE 50TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-2248
Practice Address - Country:US
Practice Address - Phone:503-238-5203
Practice Address - Fax:503-238-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR087006211N6363LP0808X
OR964103TA0400X, 103TC1900X
OR1690103TC1900X
ORAC00106171100000X
OR0896175F00000X
ORDO19964204D00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR223347Medicaid
OR150591Medicaid
OR298940Medicaid
OR240090Medicaid
OR083373Medicaid
OR028298Medicaid
OR116582Medicare ID - Type UnspecifiedWENDY MEDICARE
OR116583Medicare ID - Type UnspecifiedLUSIJAH MEDICARE
ORF82584Medicare UPIN
ORP09140Medicare UPIN