NPIMap

Organization Active NPI

Cerulean Blue Therapy, LLC

  • Community/Behavioral Health Agency
  • Portland, OR
National Provider Identifier
1104516459
Registry record updated May 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CERULEAN BLUE THERAPY, LLC
Practice address
900 NW Lovejoy St Apt 515
Portland, OR 97209-3474
Phone
(503) 702-0554
NPI assigned
May 10, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2023

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

Authorized official

Name
Katharine Elizabeth Fazal, LMFTNPI 1689909301
Title
Owner
Phone
(503) 702-0554

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
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

900 NW Lovejoy St Apt 515
Portland, OR 97209-3474

Mailing address

900 NW Lovejoy St Apt 515
Portland, OR 97209-3474
Phone (503) 702-0554

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1683676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683676800000",
    "number": "1104516459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 NW LOVEJOY ST APT 515",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093474",
            "telephone_number": "503-702-0554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 NW LOVEJOY ST APT 515",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093474",
            "telephone_number": "503-702-0554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CERULEAN BLUE THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-10",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A",
        "authorized_official_last_name": "FAZAL",
        "authorized_official_first_name": "KATHARINE",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-702-0554",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "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 May 10, 2023; 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.