Active NPI
Rochelle Jeaness Lake, MA, QMHP
- Counselor
- Portland, OR
National Provider Identifier
1093854978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 1312 SW Washington St
Portland, OR 97208-3007 - Phone
- (503) 535-1150
- Fax
- (503) 535-1191
- NPI assigned
- Feb 6, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
1312 SW Washington St
Portland, OR 97208-3007
Mailing address
18524 NW Redwing Way
#201
Beaverton, OR 97006
Phone (503) 535-1150
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
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093854978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18524 NW REDWING WAY",
"address_2": "#201",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "97006",
"telephone_number": "503-535-1150",
"fax_number": "503-535-1191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1312 SW WASHINGTON ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083007",
"telephone_number": "503-535-1150",
"fax_number": "503-535-1191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKE",
"first_name": "ROCHELLE",
"middle_name": "JEANESS",
"name_prefix": "Mrs.",
"credential": "MA, QMHP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.