Active NPI
Jill Corvelli, LPC, CADC, CGAC
- Professional Counselor
- Portland, OR
National Provider Identifier
1205258324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C4506
- Practice address
- 14600 NW Cornell Rd
Portland, OR 97229-5442 - Phone
- (503) 645-3581
- NPI assigned
- Jan 8, 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C4506 | OR | Primary |
Addresses
Primary practice location
14600 NW Cornell Rd
Portland, OR 97229-5442
Mailing address
328 Kenwood Rd
Lake Oswego, OR 97034-3832
Phone (503) 708-8082
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2025 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C4506 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522713600000",
"number": "1205258324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "328 KENWOOD RD",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970343832",
"telephone_number": "503-708-8082",
"fax_number": "503-893-3062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14600 NW CORNELL RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972295442",
"telephone_number": "503-645-3581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORVELLI",
"first_name": "JILL",
"credential": "LPC, CADC, CGAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-01-08",
"last_updated": "2018-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C4506",
"primary": true
}
],
"identifiers": [],
"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 Apr 3, 2018; 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.