Active NPI
Rex Michael
- Mental Health Counselor
- Portland, OR
National Provider Identifier
1043786460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- R10483
- Practice address
- 12636 SE Stark St BLDG J
Portland, OR 97233-1058 - Phone
- (661) 476-4279
- NPI assigned
- Oct 24, 2018
- Reactivated
- Mar 18, 2025
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | R10483 | OR | Primary |
Addresses
Primary practice location
12636 SE Stark St BLDG J
Portland, OR 97233-1058
Mailing address
2717 SE 15TH Ave Lowr Unit
Portland, OR 97202-2205
Phone (661) 476-4279
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
| License | State | Type | Specialty |
|---|---|---|---|
| R10483 | OR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742428800000",
"number": "1043786460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2717 SE 15TH AVE LOWR UNIT",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972022205",
"telephone_number": "661-476-4279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12636 SE STARK ST BLDG J",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972331058",
"telephone_number": "661-476-4279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICHAEL",
"first_name": "REX",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-10-24",
"last_updated": "2025-03-20",
"certification_date": "2025-03-20",
"deactivation_date": "2024-12-05",
"reactivation_date": "2025-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OR",
"license": "R10483",
"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 Mar 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.