Portland Neurodivergent Clinic LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

PORTLAND NEURODIVERGENT CLINIC LLC

Practice address

1250 NW Kearney St Apt 1306
Portland, OR 97209-4083

Phone

(971) 202-0047

NPI assigned

Nov 12, 2024

Organization subpart

No

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

Authorized official

Name

Cassandra Fallon MiasnikovNPI 1275365314

Title

Owner/Clinical Director

Phone

(971) 202-0047

Specialties & licenses 1

Addresses

Other names 1

• Portland Neurodivergent Clinic Other name

Practitioners 1

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

• Cassandra Miasnikov

  • Mental Health Counselor
  • Portland, OR
  • NPI 1275365314
  NPD Authorized official

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

{
    "created_epoch": "1731369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731369600000",
    "number": "1194549691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 NW KEARNEY ST APT 1306",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972094083",
            "telephone_number": "971-202-0047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 NW KEARNEY ST APT 1306",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972094083",
            "telephone_number": "971-202-0047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND NEURODIVERGENT CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-12",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-11",
        "status": "A",
        "authorized_official_last_name": "MIASNIKOV",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_middle_name": "FALLON",
        "authorized_official_title_or_position": "OWNER/CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "971-202-0047"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portland Neurodivergent Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• 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 Nov 12, 2024; 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.