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Dietrich Lamont Mcdaniel , CADCII, CRM, PSS, QMHAI

Counselor - Addiction (Substance Use Disorder) β€’ Gresham, OR

Active NPI 1548752199 Individual Practitioner Male Practitioner
Practice location in NPPES

620 Ne 2nd St
Gresham, OR 970307514

Call 9712743757 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

620 Ne 2nd St

Gresham, OR 970307514

Telephone 9712743757
Fax 5039125740
Organization at the Same NPPES Address or Phone
Native American Rehabilitation Assoc Inc Facility NPI 1942747761

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

NPI first issued

2018

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Compared with the same specialty in Gresham and Oregon

81 active clinicians are listed under Counselor - Addiction (Substance Use Disorder) with a practice address in Gresham, OR (4,040 in Oregon).

Addresses are self-reported to NPPES and may be out of date.

Telehealth indicator in Gresham

0% of these 81 clinicians have the CMS telehealth indicator.

0% of these 81 clinicians are listed by CMS as accepting Medicare assignment.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2024-10-15
Counselor - Addiction (Substance Use Disorder) Primary Specialty

NUCC Taxonomy Code: 101YA0400X

License # reported to NPPES OR 22-11-20216
Counselor - Addiction (Substance Use Disorder)

NUCC Taxonomy Code: 101YA0400X

License # reported to NPPES OR 17-CRM-068
Counselor - Mental Health

NUCC Taxonomy Code: 101YM0800X

License # reported to NPPES OR 23-QMHA-I-003592
Peer Specialist

NUCC Taxonomy Code: 175T00000X

License # reported to NPPES OR THW000001862

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Oregon Medical Board.
Look Up on State Board Site

Clinicians Sharing This Practice Address or Phone

Clinicians sharing this NPPES address, phone or fax; a shared contact does not mean they work together.

1 listed
Amy Berg , PMHNP

Nurse Practitioner - Psychiatric/Mental Health

NPI 1205204799

Psychiatric-Mental Health Nurse Practitioner

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

12 Historical Events
πŸ“
Updated Business Mailing Address October 15, 2024

Registered at 1776 SW MADISON ST, PORTLAND, OR 972051715 (Tel: 5032241044)

πŸ‘€
Provider Name / Credentials Updated October 15, 2024

Recorded as DIETRICH MCDANIEL, CADCII/CRM/PSS/QMHAI

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) October 15, 2024

Counselor (license number reported to NPPES: OR 17-CRM-068)

πŸ“
Updated Practice Location October 04, 2024

Registered at 620 NE 2ND ST, GRESHAM, OR 970307514 (Tel: 9712743757)

πŸ“
Updated Business Mailing Address October 04, 2024

Registered at 620 NE 2ND ST, GRESHAM, OR 970307514 (Tel: 9712743757)

πŸ‘€
Provider Name / Credentials Updated October 04, 2024

Recorded as DIETRICH MCDANIEL, CADC 2

βœ…
NPI Profile Active May 30, 2018

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) May 30, 2018

Registered at 10564 SE WASHINGTON ST, PORTLAND, OR 972162809 (Tel: 9713228231)

πŸ“
Business Mailing Address (Initial Record) May 30, 2018

Registered at 10564 SE WASHINGTON ST, PORTLAND, OR 972162809 (Tel: 9713228231)

πŸ‘€
Provider Name / Credentials (Initial Record) May 30, 2018

Recorded as DIETRICH MCDANIEL, CRM

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) May 30, 2018

Peer Specialist (license number reported to NPPES: OR 17-CRM-068)

🟒
Initial NPI Registration & Enumeration May 30, 2018

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1548752199
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 30, 2018
Last Update: October 15, 2024
Sole Proprietor: No

Mailing Address

1776 Sw Madison St

Portland, OR 972051715

Phone: 5032241044

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.