Provider Demographics
NPI:1477444297
Name:MCKESSEY, JEREMIAH F (CRM, PSS, QMHA-R)
Entity type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:F
Last Name:MCKESSEY
Suffix:
Gender:M
Credentials:CRM, PSS, QMHA-R
Other - Prefix:MR
Other - First Name:JEREMIAH
Other - Middle Name:
Other - Last Name:MCKESSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1405 SW PARK AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-3453
Mailing Address - Country:US
Mailing Address - Phone:503-512-3507
Mailing Address - Fax:
Practice Address - Street 1:338 NW 5TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3814
Practice Address - Country:US
Practice Address - Phone:503-512-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health