Individual provider Active NPI

Kevin Tomlin, LPC

  • Addiction (Substance Use Disorder) Counselor
  • Portland, OR
National Provider Identifier
1043640873
Registry record updated Jan 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
C3832 Issued in OR
Practice address
19500 SE Stark St
Portland, OR 97233-5757
Phone
(503) 249-3434
NPI assigned
Nov 14, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 10-12-53 OR
Addiction (Substance Use Disorder) Counselor 101YA0400X 60407047 WA
Addiction (Substance Use Disorder) Counselor 101YA0400X 60801992 WA
Addiction (Substance Use Disorder) Counselor 101YA0400X C3832 OR Primary

Addresses

Primary practice location

19500 SE Stark St
Portland, OR 97233-5757

Mailing address

19500 SE Stark St
Portland, OR 97233-5757
Phone (503) 669-2286

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
C3832ORMDAddiction (Substance Use Disorder) Counselor
60407047WAMDAddiction (Substance Use Disorder) Counselor
60801992WAMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

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

{
    "created_epoch": "1384387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547769600000",
    "number": "1043640873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19500 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972335757",
            "telephone_number": "503-669-2286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19500 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972335757",
            "telephone_number": "503-249-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOMLIN",
        "first_name": "KEVIN",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-14",
        "last_updated": "2019-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "10-12-53",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "60407047",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "60801992",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "C3832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jan 18, 2019; 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.