NPI 1023155207

Staley Wood Mims, QMHPMED

Practitioner Adult Companion Portland, OR

Practice location

Address: 2330 NE Siskiyou St, Portland, OR 97212-2471
Phone: (503) 528-0757
Fax: (503) 528-0764
Mailing address: 3602 SE 28th Pl APT 15, Portland, OR 97202-3070

Registered specialties (2)

Adult Companion Primary

Nursing Service Related Providers Taxonomy 372600000X

Other Adult Companion providers in Oregon →

Mental Health Counselor

Behavioral Health & Social Service Providers Taxonomy 101YM0800X

Other Counselor providers in Oregon →

Registry record

NPI: 1023155207
Entity type: Individual
Sex (as registered): Male
NPI issued: 30 Jan 2007
Record last updated: 11 Sep 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.