NPIMap

Organization Active NPI

Octave Behavioral Michigan PC

  • Psychologist
  • Salem, OR
National Provider Identifier
1073367256
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
OCTAVE BEHAVIORAL MICHIGAN PC
Practice address
1127 Broadway St NE Ste 310
Salem, OR 97301-1143
Phone
(415) 360-3833
Fax
(628) 234-3048
NPI assigned
Apr 15, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Authorized official

Name
Kym Everett
Title
VP, Revenue Operations
Phone
(650) 504-2289

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

1127 Broadway St NE Ste 310
Salem, OR 97301-1143

Mailing address

625 Market St FL 15
San Francisco, CA 94105-3316
Phone (650) 504-2289

National Provider Directory

National Provider Directory
Tax ID family
Octave Behavioral Michigan PC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713139200000",
    "number": "1073367256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 MARKET ST FL 15",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941053316",
            "telephone_number": "650-504-2289",
            "fax_number": "628-234-3048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1127 BROADWAY ST NE STE 310",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973011143",
            "telephone_number": "415-360-3833",
            "fax_number": "628-234-3048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCTAVE BEHAVIORAL MICHIGAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-15",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A",
        "authorized_official_last_name": "EVERETT",
        "authorized_official_first_name": "KYM",
        "authorized_official_title_or_position": "VP, REVENUE OPERATIONS",
        "authorized_official_telephone_number": "650-504-2289"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; 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.