NPIMap

Organization Active NPI

Mindsights, P.C.

  • Psychologist
  • Portland, OR
National Provider Identifier
1124465182
Registry record updated Sep 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1568 Issued in OR
Legal business name
MINDSIGHTS, P.C.
Practice address
516 SE Morrison St
Suite 1110
Portland, OR 97214-2327
Phone
(503) 222-0707
Fax
(503) 764-9646
NPI assigned
May 31, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2022

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

Authorized official

Name
Dr. Freda B Bax, PSY.D.NPI 1497769400
Title
Secretary/Treasurer
Phone
(503) 222-0707

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 1568 OR Primary
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X 1568 OR

Addresses

Primary practice location

516 SE Morrison St
Suite 1110
Portland, OR 97214-2327

Mailing address

847 NE 19TH Ave Ste 150
Portland, OR 97232-2686
Phone (503) 222-0707

Other identifiers 1

IdentifierTypeStateIssuer
500661389MedicaidOR

National Provider Directory

National Provider Directory

Locations

847 NE 19th Ave
Ste 150
Portland, OR 97232
Phone (503) 222-0707

Practitioners & affiliated clinicians

Practitioners 12

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": "1369958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661990400000",
    "number": "1124465182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "847 NE 19TH AVE STE 150",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322686",
            "telephone_number": "503-222-0707",
            "fax_number": "503-764-9646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 SE MORRISON ST",
            "address_2": "SUITE 1110",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142327",
            "telephone_number": "503-222-0707",
            "fax_number": "503-764-9646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDSIGHTS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-31",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "status": "A",
        "authorized_official_last_name": "BAX",
        "authorized_official_first_name": "FREDA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "SECRETARY/TREASURER",
        "authorized_official_telephone_number": "503-222-0707",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "OR",
            "license": "1568",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "OR",
            "license": "1568",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500661389",
            "state": "OR"
        }
    ],
    "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 Sep 1, 2022; 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.