Pacific Mental Health Clinic LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

PACIFIC MENTAL HEALTH CLINIC LLC

Practice address

16323 SE Stark St Ste 102
Portland, OR 97233-3942

Phone

(503) 265-8922

Fax

(971) 420-2990

NPI assigned

Mar 21, 2024

Organization subpart

No

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

Authorized official

Name

Ms. Kadra Abdullahi Mohamed, RNNPI 1033981279

Title

Owner

Phone

(206) 489-8775

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Phyllis Deshun Hursey, MD

  • Family Medicine Physician
  • Portland, OR
  • NPI 1427029537
  Medicare reassignment NPD
• Kadra A Mohamed I, RN

  • Registered Nurse
  • Kent, WA
  • NPI 1033981279
  NPD Authorized official
• Lynn M James, CADC III/CSWA/QMHP-C

  • Mental Health Counselor
  • Portland, OR
  • NPI 1093931370
  NPD
• Siidomar Hasem

  • Addiction (Substance Use Disorder) Counselor
  • Portland, OR
  • NPI 1780509513
  NPD (past)
• John Michael Jr., CADC-R

  • Addiction (Substance Use Disorder) Counselor
  • Portland, OR
  • NPI 1346109725
  NPD (past)

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

{
    "created_epoch": "1710979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771891200000",
    "number": "1699535195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16323 SE STARK ST STE 102",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972333942",
            "telephone_number": "503-265-8922",
            "fax_number": "971-420-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16323 SE STARK ST STE 102",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972333942",
            "telephone_number": "503-265-8922",
            "fax_number": "971-420-2990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC MENTAL HEALTH CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-21",
        "last_updated": "2026-02-24",
        "certification_date": "2026-02-24",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "KADRA",
        "authorized_official_middle_name": "ABDULLAHI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-489-8775",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pacific Footwear Company, Inc.
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• Pacific Imaging Associates LLC
• Pacific Medical, Inc.
• Pacific Mental Health Oregon LLC
• Pacific Neurosurgical PC
• Pacific Northwest Acupuncture&Herbal Clinic,LLC
• Pacific Northwest Behavioral Health, LLC
• Pacific Northwest Oncology Services

• Clinical Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.