Individual ProviderNaomi Diane KidderCounselorBehavioral Health & Social Service ProvidersPractice Address2722 NE 105th Ave, Portland, OR 97220-2818(503) 577-9001PECOS EnrollmentBased on the most recent information from CMS, provider Naomi Diane Kidder does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1235902420Provider TypeIndividualFull NameKidder, Naomi DianeCredentialMA, LPCGenderFemaleSole ProprietorNoEnumeration Date10/31/2023Last Updated10/31/2023Contact InformationPractice LocationPractice Address2722 NE 105th Ave, Portland, OR 97220-2818Phone(503) 577-9001FaxUnlisted FaxMailing LocationMailing Address2722 NE 105th Ave, Portland, OR 97220-2818Phone(503) 577-9001FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseC7001OregonCode101YM0800XDescriptionCounselorBehavioral Health & Social Service ProvidersLicense80926Texas