Provider Demographics
NPI:1205973179
Name:PENSE, JOE RICHARD (QMHA, CADC 1)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:RICHARD
Last Name:PENSE
Suffix:
Gender:M
Credentials:QMHA, CADC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 SW WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2139
Mailing Address - Country:US
Mailing Address - Phone:503-544-6019
Mailing Address - Fax:
Practice Address - Street 1:5131 SW WINDSOR CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221
Practice Address - Country:US
Practice Address - Phone:503-544-6019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered372600000XNursing Service Related ProvidersAdult Companion
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health