Active NPI
Isabel S Kim, MA
- Mental Health Counselor
- Portland, OR
National Provider Identifier
1114553625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 4035 NE Sandy Blvd Ste 200
Portland, OR 97212-5331 - Phone
- (971) 940-2601
- Fax
- (971) 275-1534
- NPI assigned
- Mar 16, 2020
- Last updated
- Mar 16, 2020
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
4035 NE Sandy Blvd Ste 200
Portland, OR 97212-5331
Mailing address
14605 SW Osprey Dr Apt 1325
Beaverton, OR 97007-7967
Phone (971) 227-2133
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Portland Neurofeedback, LLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584316800000",
"number": "1114553625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14605 SW OSPREY DR APT 1325",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970077967",
"telephone_number": "971-227-2133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4035 NE SANDY BLVD STE 200",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972125331",
"telephone_number": "971-940-2601",
"fax_number": "971-275-1534"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "ISABEL",
"middle_name": "S",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-16",
"last_updated": "2020-03-16",
"certification_date": "2020-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental 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 Mar 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.