NPIMap

Organization Active NPI

Connective Therapy Collective

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1114561735
Registry record updated Feb 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
CONNECTIVE THERAPY COLLECTIVE
Practice address
4531 SE Belmont St Ste 117
Portland, OR 97215-1675
Phone
(414) 550-0257
NPI assigned
Nov 6, 2019
Organization subpart
Yes
Parent organization
1053674949As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 1, 2021

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

Authorized official

Name
Angela Gunn, LCSW CST
Title
Ceo
Phone
(971) 361-8303

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary
Clinic/Center 261Q00000X

Addresses

Primary practice location

4531 SE Belmont St Ste 117
Portland, OR 97215-1675

Mailing address

5510 N Commercial Ave
Portland, OR 97217-2340
Phone (971) 361-8303

Other practice location 1

5510 N Commercial Ave
Portland, OR 97217-2340
Phone (971) 361-8303 ext. 3

Other names 2

  • Connective Therapy Collective Doing business as
  • Connective Sex Therapy Former legal business name

National Provider Directory

National Provider Directory
Part of
Connective Therapy Collective

Locations

4531 SE Belmont St
Ste 117
Portland, OR 97215
Phone (503) 308-8684

11220 SE Stark St
Ste 1
Portland, OR 97216
Phone (971) 361-8303

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1572998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612137600000",
    "number": "1114561735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5510 N COMMERCIAL AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972172340",
            "telephone_number": "971-361-8303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4531 SE BELMONT ST STE 117",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972151675",
            "telephone_number": "414-550-0257"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5510 N Commercial Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972172340",
            "country_code": "US",
            "telephone_number": "971-361-8303 x3",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CONNECTIVE THERAPY COLLECTIVE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "1053674949",
        "enumeration_date": "2019-11-06",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A",
        "authorized_official_last_name": "GUNN",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "971-361-8303",
        "authorized_official_credential": "LCSW CST"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Connective Therapy Collective",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Connective Sex Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Feb 1, 2021; 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.