Active NPI
Stacy Ann Wilson, CRM, QMHA, CADC
- Addiction (Substance Use Disorder) Counselor
- Portland, OR
National Provider Identifier
1386277150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 25-03-11415
- Practice address
- 2901 E Burnside St
Portland, OR 97214-1831 - Phone
- (503) 238-5203
- NPI assigned
- Feb 19, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 24-QMHA-I-004213 | OR | |
| Peer Specialist | 175T00000X | 20-CRM-007 | OR | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 25-03-11415 | OR | Primary |
Addresses
Primary practice location
2901 E Burnside St
Portland, OR 97214-1831
Mailing address
2901 E Burnside St
Portland, OR 97214-1831
Phone (503) 238-5203
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-QMHA-I-004213 | OR | MD | Specialist |
| 20-CRM-007 | OR | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741046400000",
"number": "1386277150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2901 E BURNSIDE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972141831",
"telephone_number": "503-238-5203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2901 E BURNSIDE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972141831",
"telephone_number": "503-238-5203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "STACY",
"middle_name": "ANN",
"credential": "CRM, QMHA, CADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-19",
"last_updated": "2025-03-04",
"certification_date": "2025-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OR",
"license": "24-QMHA-I-004213",
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OR",
"license": "20-CRM-007",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OR",
"license": "25-03-11415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 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.