Active NPI
Regina Theresa Burck, QMHP
- Mental Health Counselor
- Gresham, OR
National Provider Identifier
1225656366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 24-QMHPC-001573
- Practice address
- 21440 SE Stark St
Gresham, OR 97030-2024 - Phone
- (971) 703-4623
- NPI assigned
- Jul 6, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 24-QMHPC-001573 | OR | Primary |
Addresses
Primary practice location
21440 SE Stark St
Gresham, OR 97030-2024
Mailing address
11010 SE Division St Ste 200
Portland, OR 97266-6400
Phone (971) 703-4623
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24-QMHPC-001573 | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753228800000",
"number": "1225656366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11010 SE DIVISION ST STE 200",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972666400",
"telephone_number": "971-703-4623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21440 SE STARK ST",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970302024",
"telephone_number": "971-703-4623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURCK",
"first_name": "REGINA",
"middle_name": "THERESA",
"credential": "QMHP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-06",
"last_updated": "2025-07-23",
"certification_date": "2025-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "24-QMHPC-001573",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.