Portland Anxiety Clinic

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2247 Issued in OR

Legal business name

PORTLAND ANXIETY CLINIC

Practice address

1130 SW Morrison St Ste 619
Portland, OR 97205-2217

Phone

(503) 313-0028

NPI assigned

Sep 7, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Jill Davidson, PSY.D.NPI 1841508553

Title

Psychologist / Owner

Phone

(503) 313-0028

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jill Ashley Davidson, PSY.D

  • Clinical Psychologist
  • Portland, OR
  • NPI 1841508553
  NPD (past) Authorized official

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

{
    "created_epoch": "1536278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536278400000",
    "number": "1033692991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 SW MORRISON ST STE 619",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052217",
            "telephone_number": "503-313-0028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 SW MORRISON ST STE 619",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052217",
            "telephone_number": "503-313-0028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND ANXIETY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-07",
        "last_updated": "2018-09-07",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "PSYCHOLOGIST  / OWNER",
        "authorized_official_telephone_number": "503-313-0028",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "2247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JILL DAVIDSON NPI",
            "identifier": "1841508553",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2018; 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.