David Ixtlahuac, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

T1543 Issued in OR

Practice address

1110 SE Alder St Ste 301
Portland, OR 97214-2400

Phone

(971) 303-8243

NPI assigned

Apr 12, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Kallpa Connection

  • Marriage & Family Therapist
  • Portland, OR
  • NPI 1760356836
  NPD Authorized official
• Soultenders Psychological Services, Inc.

  • Clinical Social Worker
  • Arcadia, CA
  • NPI 1235810722
  NPD (past)
• Soultenders, Inc.

  • Clinical Psychologist
  • Arcadia, CA
  • NPI 1164617007
  NPD (past)

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

{
    "created_epoch": "1523491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583193600000",
    "number": "1144727348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3705 N OVERLOOK BLVD APT 311",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972272036",
            "telephone_number": "971-303-8243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 SE ALDER ST STE 301",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142400",
            "telephone_number": "971-303-8243"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2600 Mission St Ste 201",
            "address_purpose": "LOCATION",
            "city": "San Marino",
            "state": "CA",
            "postal_code": "911081676",
            "country_code": "US",
            "telephone_number": "626-623-7478",
            "fax_number": "626-737-6034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IXTLAHUAC",
        "first_name": "DAVID",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-12",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "OR",
            "license": "T1543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OBLPCT",
            "identifier": "T1543",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "david@soulselfpdx.com",
            "affiliation": "N",
            "endpointDescription": "Business Email",
            "address_1": "1110 SE Alder St Ste 301",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972142400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristina Ivy, LCSW
• Sherylle Lynne Cadiente Iwaki, PHARM.D
• Dawn Ayume Iwamasa, MA, CCLS, MT-BC
• Sharyn Iwaniec, PT
• Ellen L. Iwasaki, FNP
• Ahmed Iya, RN BSN
• Sudarshan Iyer
• Nalini Iype, MA
• Shawn Izadi, MD
• Orna Izakson, ND

• Marriage & Family Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Marriage & Family Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 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.

Verify at the official NPI Registry.