Timothy A A Rogers
Individual provider Active NPI Mental Health Counselor · Portland, OR
NPI 1053063487 · NPPES record last updated Jan 26, 2022
Key facts
- NPI
- 1053063487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- LMSW-18262 (AZ)
- Practice address
- 1505 NE 122ND Ave
Portland, OR 97230-1911 - Phone
- (503) 688-5361
- NPI assigned
- Jan 26, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMSW-18262 | AZ | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LMSW-18262 | AZ | Yes |
Addresses
Primary practice location
1505 NE 122ND Ave
Portland, OR 97230-1911
Mailing address
1505 NE 122ND Ave
Portland, OR 97230-1911
Phone (503) 688-5361
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All providers in Portland, OR · Mental Health Counselor in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.