Individual provider Active NPI

Kelsey Brenna Movchan, PSS, CRM, QMHA-R

  • Peer Specialist
  • Portland, OR
National Provider Identifier
1861250649
Registry record updated Apr 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Peer SpecialistTaxonomy code 175T00000X
License
111927 Issued in OR
Practice address
3636 NE Broadway St
Portland, OR 97232-1823
Phone
(503) 548-0346
Fax
(503) 621-0200
NPI assigned
Mar 7, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 25-QMHA-R-7290 OR
Peer Specialist 175T00000X 111927 OR Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 25-CRM-4213 OR

Addresses

Primary practice location

3636 NE Broadway St
Portland, OR 97232-1823

Mailing address

211 SE Caruthers St
Portland, OR 97214-4502
Phone (971) 217-9008

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

LicenseStateTypeSpecialty
25-CRM-4213ORMDAddiction (Substance Use Disorder) Counselor
25-QMHA-R-7290ORMDMental Health Counselor
111927ORMDPeer Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Native American Rehabilitation Assoc Inc Past Accepting new patients
Native American Rehabilitation Assoc Inc PastSince Sep 28, 2025 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1709769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777248000000",
    "number": "1861250649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 SE CARUTHERS ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144502",
            "telephone_number": "971-217-9008",
            "fax_number": "971-260-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3636 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321823",
            "telephone_number": "503-548-0346",
            "fax_number": "503-621-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOVCHAN",
        "first_name": "KELSEY",
        "middle_name": "BRENNA",
        "credential": "PSS, CRM, QMHA-R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-07",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "25-QMHA-R-7290",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "111927",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "25-CRM-4213",
            "primary": false
        }
    ],
    "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 Apr 27, 2026; 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.