Killian Drake Shields, QMHP

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

1650 NE 32ND Ave Apt 418
Portland, OR 97232-3454

Phone

(541) 340-9016

NPI assigned

Jun 21, 2016

Sex

Male

Sole proprietor

No

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)

Enrolled

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.

• Mid-Columbia Center for Living

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • The Dalles, OR
  • NPI 1699745794
  NPD (past)

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

{
    "created_epoch": "1466467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654214400000",
    "number": "1407206394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8915 SW CENTER ST",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236307",
            "telephone_number": "503-726-3690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 NE 32ND AVE APT 418",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972323454",
            "telephone_number": "541-340-9016"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2210 N Eldorado Ave",
            "address_purpose": "LOCATION",
            "city": "Klamath Falls",
            "state": "OR",
            "postal_code": "976016418",
            "country_code": "US",
            "telephone_number": "541-883-1030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIELDS",
        "first_name": "KILLIAN",
        "middle_name": "DRAKE",
        "credential": "QMHP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-21",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Taylor Shields, QMHA
• Joyce Elaine Shields, L.AC.
• Kaylee Shields, BCBA
• Kelley Shields
• Kelly A Shields, LPC
• Kimberly Shields, LAC
• Kimberly A Shields, DO
• Michael Austin Shields
• Michelle Renee Shields, LMT
• Jenna Marie Shiferaw, RN

• Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; 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.