Individual provider Active NPI

Ollie Gibson-Lavell, LICSW

  • Clinical Social Worker
  • Vancouver, WA
National Provider Identifier
1073096459
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LW61485936 Issued in WA
Practice address
19120 SE 34TH St Ste 201
Vancouver, WA 98683-1430
Phone
(360) 397-8246
NPI assigned
Sep 11, 2018
Last updated
Dec 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X
Clinical Social Worker 1041C0700X LW61485936 WA Primary
Clinical Social Worker 1041C0700X L11169 OR
Clinical Social Worker 1041C0700X 61498312 WA

Addresses

Primary practice location

19120 SE 34TH St Ste 201
Vancouver, WA 98683-1430

Mailing address

19120 SE 34TH St Ste 201
Vancouver, WA 98683-1430
Phone (503) 453-6673

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20231109002090 WA Practitioner - Clinical Social Worker 9739536947 Reassigns benefits to 1 organization
I20250319004093 OR Practitioner - Clinical Social Worker 9739536947 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1700 NW Civic Dr
Suite 310
Gresham, OR 97030-3774
Phone (503) 666-8832

19120 SE 34TH St
Suite 201
Vancouver, WA 98683-1430
Phone (360) 906-1190

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
61498312WAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Western Psychological and Counseling Services LLC Clinical CurrentSince Feb 12, 2025 Accepting new patients
Lifeline Connections PastSince Aug 1, 2023 Accepting new patients

Locations

4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392

880 82nd Dr
Gladstone, OR 97027
Phone (503) 626-9494

1700 NW Civic Dr
Ste 310
Gresham, OR 97030
Phone (503) 666-8832

18765 SW Boones Ferry Rd
Ste 100
Tualatin, OR 97062
Phone (503) 612-1000

19120 SE 34th St
Ste 201
Vancouver, WA 98683
Phone (360) 906-1190

Networks

  • devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1073096459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19120 SE 34TH ST STE 201",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986831430",
            "telephone_number": "503-453-6673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19120 SE 34TH ST STE 201",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986831430",
            "telephone_number": "360-397-8246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON-LAVELL",
        "first_name": "OLLIE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-11",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61485936",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L11169",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "61498312",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.