Staley Wood Mims III, QMHP MED

Primary specialty

Adult CompanionTaxonomy code 372600000X

Practice address

2330 NE Siskiyou St
Portland, OR 97212-2471

Phone

(503) 528-0757

Fax

(503) 528-0764

NPI assigned

Jan 30, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cascadia

  • Adult Companion
  • Portland, OR
  • NPI 1013055953
  NPD (past)
• Cascadia Health

  • Multi-Specialty Clinic/Center
  • Portland, OR
  • NPI 1043397219
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1023155207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3602 SE 28TH PL APT 15",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972023070",
            "telephone_number": "503-771-0968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 NE SISKIYOU ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972122471",
            "telephone_number": "503-528-0757",
            "fax_number": "503-528-0764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIMS",
        "first_name": "STALEY",
        "middle_name": "WOOD",
        "name_suffix": "III",
        "credential": "QMHP MED",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Simon Michael Milshtein I
• Emma Alexis Milton
• Emma Milward
• Milwaukie Natural Medicine, LLC
• Michael Mims
• Margaret Jane Min, PT, DPT
• Ryan Minarik, ND, LAC
• Tara Lynn Minassian
• Anna Aylin Minasyan, PHARMD, RPH
• Marissa Minato, LCSW

• Adult Companion in Portland, OR
• Providers in Portland, OR by specialty
• Adult Companion in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.