NPIMap

Organization Active NPI

Sprout Therapy PDX LLC

Doing business as Sprout Therapy PDX

  • Counselor
  • Portland, OR
National Provider Identifier
1093346777
Registry record updated Mar 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
SPROUT THERAPY PDX LLC
Doing business as
Sprout Therapy PDX
Practice address
7704 N Hereford Ave
Portland, OR 97203-3434
Phone
(971) 319-4827
Fax
(503) 662-6220
NPI assigned
Jan 30, 2020
Last updated
Mar 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2026

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

Authorized official

Name
Emelie Angelina Douglas, LPCNPI 1467821199
Title
Ceo
Phone
(503) 209-0914

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X Primary

Addresses

Primary practice location

7704 N Hereford Ave
Portland, OR 97203-3434

Mailing address

9133 N Allegheny Ave
Portland, OR 97203-2303
Phone (503) 209-0914

Other practice location 1

6011 NE Oregon St
Portland, OR 97213-4300
Phone (971) 319-4827

Other names 1

  • Sprout Therapy PDX Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251113003039 OR Part B Supplier - Clinic/Group Practice 6507357910 Receives reassigned benefits from 20 practitioners
Practice locations: Portland, OR

National Provider Directory

National Provider Directory

Locations

6011 NE Oregon St
Portland, OR 97213
Phone (971) 256-5766

6011 NE Oregon St
Ste 100
Portland, OR 97213
Phone (971) 319-4827

7704 N Hereford Ave
Portland, OR 97203
Phone (971) 319-4827

Practitioners & affiliated clinicians

Practitioners 41

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1580342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773273600000",
    "number": "1093346777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9133 N ALLEGHENY AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972032303",
            "telephone_number": "503-209-0914",
            "fax_number": "503-662-6220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7704 N HEREFORD AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972033434",
            "telephone_number": "971-319-4827",
            "fax_number": "503-662-6220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6011 NE Oregon St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972134300",
            "country_code": "US",
            "telephone_number": "971-319-4827",
            "fax_number": "503-662-6221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPROUT THERAPY PDX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-30",
        "last_updated": "2026-03-12",
        "certification_date": "2026-03-12",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "EMELIE",
        "authorized_official_middle_name": "ANGELINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "503-209-0914",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sprout Therapy PDX",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sprout Therapy PDX",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.