Martine Rose Wallenberg, MS, ED.D, LMHC, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C11126 Issued in OR

Practice address

5441 S Macadam Ave Ste R
Portland, OR 97239-3822

Phone

(386) 546-4634

NPI assigned

Aug 12, 2019

Last updated

Apr 16, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mindful Therapy Group PCGroup PAC ID 4981872561, 654 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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.

• Mindful Therapy Group PC

  dba Mindful Therapy Group

  • Clinical Social Worker
  • Mountlake Terrace, WA
  • NPI 1316238678

  OR

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776297600000",
    "number": "1184270621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5441 S MACADAM AVE STE R",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393822",
            "telephone_number": "386-546-4634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5441 S MACADAM AVE STE R",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393822",
            "telephone_number": "386-546-4634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLENBERG",
        "first_name": "MARTINE",
        "middle_name": "ROSE",
        "name_prefix": "Ms.",
        "credential": "MS, ED.D, LMHC, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-12",
        "last_updated": "2026-04-16",
        "certification_date": "2026-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C11126",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH23604",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "urpathenlightenment@gmail.com",
            "affiliation": "Y",
            "affiliationName": "Children's Home Society of Florida",
            "address_1": "2400 S Ridgewood Ave",
            "city": "South Daytona",
            "state": "FL",
            "country_code": "US",
            "postal_code": "321193097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Priscilla Jane Wallace, MD
• Shai Joann Love Wallace
• Suzanne Kapuamailani Wallace, MSW, ASW, LCSW
• Valorie June Wallace, LMT
• Summer Nicole Wallaert
• Ryan Wallenberg, M.D.
• Daniel Wallenslager, PHARMD
• Olivia R Waller Setniker
• Waller Wholistic Wellness & Consulting
• Chris Waller

• Mental Health Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.