Kimberly Cantonwine, M.A.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

2415 SE 43Rd Ave Ste 200
Portland, OR 97206-1671

Phone

(503) 238-0705

NPI assigned

Jul 11, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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 1

Specialty

Mental Health Counselor

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Western Psychological and Counseling Services LLCGroup PAC ID 7719975085, 331 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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

• Western Psychological and Counseling Services LLC

  • Clinical Psychologist
  • Vancouver, WA
  • NPI 1629345731

  Mental Health

  Medicare reassignment Care Compare group NPD
• Cascadia Health

  • Primary Care Clinic/Center
  • Portland, OR
  • NPI 1144722935
  NPD (past)
• Telecare Mental Health Services of Oregon, Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Portland, OR
  • NPI 1659453686
  NPD (past)
• Telecare Mental Health Services of Oregon, Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Gresham, OR
  • NPI 1740378371
  NPD (past)
• Western Psychological and Counseling Services LLC

  • Clinical Psychologist
  • Tacoma, WA
  • NPI 1912008178

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1405036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583971200000",
    "number": "1104232032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8459",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972078459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 SE 43RD AVE STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972061671",
            "telephone_number": "503-238-0705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANTONWINE",
        "first_name": "KIMBERLY",
        "credential": "M.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-11",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "R3328",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Elizabeth Canter, MD
• Joshua Caleb Canter, ND, LAC
• Canterbury Crest, Inc.
• Christopher Jordan Cantino, AAS
• Daniel Murray Canto, LMT
• Amy Gabrielle Cantor, MD
• Grace Willson Cantor, M.A.
• Taylor Lafe Cantrall
• Amanda Nicole Cantu
• Annette Lynn Cantu, PHD

• Mental Health Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.