Active NPI
Amy Michelle Connolly, LPC
- Professional Counselor
- Portland, OR
National Provider Identifier
1023066214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C1676
- Practice address
- 4300 NE Fremont St Ste 260
Portland, OR 97213-1100 - Phone
- (503) 866-3971
- NPI assigned
- May 4, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C1676 | OR | Primary |
Addresses
Primary practice location
4300 NE Fremont St Ste 260
Portland, OR 97213-1100
Mailing address
4300 NE Fremont St Ste 260
Portland, OR 97213-1100
Phone (503) 866-3971
Other names 1
- Ms. Amy Michelle Cannon
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 16, 2026 through Feb 16, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C1676 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660089600000",
"number": "1023066214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4300 NE FREMONT ST STE 260",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972131100",
"telephone_number": "503-866-3971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4300 NE FREMONT ST STE 260",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972131100",
"telephone_number": "503-866-3971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "AMY",
"middle_name": "MICHELLE",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-04",
"last_updated": "2022-08-10",
"certification_date": "2022-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C1676",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "AMY",
"last_name": "CANNON",
"middle_name": "MICHELLE",
"prefix": "MS.",
"credential": "LPC",
"code": "1",
"type": "Former Name"
}
]
}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 Aug 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.