Active NPI
Renee Boles
- Mental Health Counselor
- Tigard, OR
National Provider Identifier
1205246691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 14755 SW Cabernet CT
Tigard, OR 97224-1539 - Phone
- (971) 217-8164
- Fax
- (833) 672-3307
- NPI assigned
- May 6, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
14755 SW Cabernet CT
Tigard, OR 97224-1539
Mailing address
14755 SW Cabernet CT
Tigard, OR 97224-1539
Phone (971) 217-8164
Other practice location 1
7175 SW Beveland Rd
Suite 105
Tigard, OR 97223-8665
Phone (971) 217-8164
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 9, 2024 through Feb 9, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652486400000",
"number": "1205246691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14755 SW CABERNET CT",
"city": "TIGARD",
"state": "OR",
"postal_code": "972241539",
"telephone_number": "971-217-8164",
"fax_number": "833-672-3307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14755 SW CABERNET CT",
"city": "TIGARD",
"state": "OR",
"postal_code": "972241539",
"telephone_number": "971-217-8164",
"fax_number": "833-672-3307"
}
],
"practiceLocations": [
{
"address_1": "7175 SW Beveland Rd",
"address_2": "Suite 105",
"address_purpose": "LOCATION",
"city": "Tigard",
"state": "OR",
"postal_code": "972238665",
"country_code": "US",
"telephone_number": "971-217-8164",
"fax_number": "866-802-8062",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BOLES",
"first_name": "RENEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-05-06",
"last_updated": "2022-05-14",
"certification_date": "2022-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.